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October 2015
Pregnancy Outcome Unit,
SA Health
Pregnancy
Outcome
in South Australia
2013
October 2015
Pregnancy Outcome in South Australia 2013
SA Health
Address:
Pregnancy Outcome (Statistics) Unit
Epidemiology Branch
SA Health, Government of South Australia
Citi Centre Building
11 Hindmarsh Square
Adelaide 5000
South Australia
Postal Address:
Pregnancy Outcome (Statistics) Unit
SA Health, Government of South Australia
PO Box 6, Rundle Mall
Adelaide 5000
South Australia
Telephone: (08) 8226 6382
Fax: (08) 8226 6291
Web: www.sahealth.gov.au
E-mail: Pregnancy.Stats@health.sa.gov.au
ISSN 0819-3835
ISBN 978-1-74243-807-8
Suggested citation: Scheil W, Jolly K, Scott J, Catcheside B, Sage L, Kennare R. Pregnancy Outcome in South Australia 2013.
Adelaide: Pregnancy Outcome Unit, SA Health, Government of South Australia, 2015.
Pregnancy Outcome in
South Australia 2013
Wendy Scheil
Kerry Jolly
Joan Scott
Britt Catcheside
Leonie Sage
Robyn Kennare
October 2015
Pregnancy Outcome Unit
SA Health
Staff
Wendy Scheil Head/Senior Medical Consultant
Joan Scott Senior Midwife
Leonie Sage Senior Midwife, Abortion Statistics
Maureen Fisher Administrative Officer
Judith Thompson Administrative Officer
Kerry Jolly Midwife
Robyn Kennare Senior Midwife, Maternal, Perinatal & Infant Mortality Committee
Acknowledgements
We would like to thank all midwives and nurses in South Australia who completed and submitted the Supplementary Birth
Records on which the perinatal data collection is based. We thank them also for responding so efficiently to our queries.
We would also like to express our sincere thanks to the following:
> doctors who notified births with congenital abnormalities and those who notified terminations of pregnancy;
> the pathology departments of teaching hospitals for autopsy information;
> the Genetics and Molecular Pathology Directorate, Women s and Children s Hospital, for cytogenetics reports;
> the Births, Deaths and Marriages Registration Division for data and perinatal death certificates;
> the Coroner s Office for Coroner s findings and autopsy reports;
> Kevin Priest of the Health Statistics Unit for his assistance in programming and provision of perinatal data to the
National Perinatal Statistics Unit and in data linkage;
> Graeme Tucker, Kamalesh Venugopal, Britt Catcheside and Anh Minh Nguyen of the Health Statistics Unit for
assistance with responding to data requests and in data linkage;
> Alison Scott for assisting with data entry;
> Maureen Fisher and Britt Catcheside for the graphics;
> Fred Calabrese of the Epidemiology Branch for his assistance with the import of electronically transferred data from
the Women s and Children s Hospital;
> Bridget Milanowski from Information Systems, Standards & Quality Unit for updating the maps; and
> Media and Communications Branch of SA Health for publication.
Pregnancy Outcome in South Australia 2013page 2
Acknowledgements
Contents
Acknowledgements ........................................................................................................2
Executive Summary .......................................................................................................10
1. Numbers and fertility rates ........................................................................................................................10
2. Place of birth ............................................................................................................................................10
3. Teenage women .......................................................................................................................................10
4. Older women and first time mothers ........................................................................................................10
5. Country of birth and race .........................................................................................................................10
6. Smoking during pregnancy and Body Mass Index .....................................................................................10
7. Antenatal care and length of stay .............................................................................................................11
8. Aboriginal women and babies ..................................................................................................................11
9. Procedures ...............................................................................................................................................11
10. Method of birth ......................................................................................................................................11
11. Multiple births ........................................................................................................................................11
12. Abortions ...............................................................................................................................................12
13. Perinatal mortality ..................................................................................................................................12
I. Introduction ...........................................................................................................13
1. The Perinatal Statistics Collection ..............................................................................................................13
2. The Abortion Statistics Collection .............................................................................................................13
II. Mothers and Babies: Characteristics & Outcomes ...............................................14
1. Place of residence of mother ....................................................................................................................14
2. Place of birth of baby ...............................................................................................................................15
3. Maternal and baby race ............................................................................................................................20
4. Maternal age ............................................................................................................................................21
5. Country of birth .......................................................................................................................................23
6. Marital status and type of patient .............................................................................................................25
7. Occupation of father and mother .............................................................................................................26
8. Previous pregnancy outcomes ...................................................................................................................27
9a. Gestation at first antenatal visit ...............................................................................................................28
9b. Body Mass Index (BMI) ............................................................................................................................28
9c. Antenatal visits .......................................................................................................................................29
9d. Type of antenatal care ............................................................................................................................29
10. Smoking .................................................................................................................................................30
11. Medical conditions .................................................................................................................................31
12. Obstetric complications ..........................................................................................................................31
Pregnancy Outcome in South Australia 2013 page 3
Contents
13. Procedures performed in current pregnancy ............................................................................................32
14a. Onset of labour ....................................................................................................................................32
14b. Reasons for induction of labour ............................................................................................................33
15a. Presentation and method of birth .........................................................................................................34
15b. Reason for caesarean section ................................................................................................................36
16. Complications of labour and birth and perineal status after birth ............................................................37
17. Fetal monitoring during labour ...............................................................................................................38
18. Analgesia for labour and anaesthesia for birth ........................................................................................38
19. Postnatal length of stay of women .........................................................................................................39
20. Sex of baby ............................................................................................................................................40
21. Birthweight and gestation ......................................................................................................................40
22. Birth injuries ...........................................................................................................................................41
23. Treatment given in neonatal period .........................................................................................................41
24. Level of care utilised ...............................................................................................................................41
25. Length of stay of babies .........................................................................................................................42
26. Congenital anomalies .............................................................................................................................42
27. Multiple births ........................................................................................................................................43
28. Perinatal mortality ..................................................................................................................................45
29. Home births ...........................................................................................................................................47
30. Birthing unit births ..................................................................................................................................49
III. Terminations of Pregnancy ...................................................................................51
1. Numbers and rates ...................................................................................................................................51
2. Age of women .........................................................................................................................................52
3. Place of residence and place where termination performed .......................................................................54
4. The reason for termination .......................................................................................................................55
5. Gestation, method and complications .......................................................................................................55
6. Previous terminations. Total termination of pregnancy rate and total first termination of pregnancy rate ...57
IV. Obstetric Profiles by Hospital Category ...............................................................59
V. Clinical and Maternity Performance Indicators ...................................................68
1. Clinical indicators .....................................................................................................................................68
1: Smoking in pregnancy ...........................................................................................................................68
2: Antenatal care in the first trimester for all women giving birth ...............................................................69
3: Episiotomy for women having their first baby and giving birth vaginally .................................................69
4: Apgar score of less than 7 at 5 minutes for births at or after term .........................................................70
5: Induction of labour for selected primiparae ...........................................................................................70
Pregnancy Outcome in South Australia 2013page 4
Contents
6: Caesarean section for selected primiparae .............................................................................................70
7: Normal (non-instrumental) vaginal birth for selected primiparae ............................................................70
8: Instrumental vaginal birth for selected primiparae ..................................................................................71
9: General anaesthetic for women giving birth by caesarean section ..........................................................71
10: Small babies among births at or after 40 weeks gestation.....................................................................71
2. Maternity performance indicators, hospitals with at least 550 births per year ............................................72
VI. Trends in Perinatal Statistics in South Australia, 1981-2013 ...............................76
Trends in Perinatal Statistics in South Australia (SA), 1981 2013 .................................................................79
VII. Summary Statistics for 2013 ..................................................................................82
1. Number of births ......................................................................................................................................82
2. Place of birth ............................................................................................................................................82
3. Sex ...........................................................................................................................................................82
4. Plurality and condition at birth ..................................................................................................................82
5. Race of women ........................................................................................................................................82
6. Obstetric interventions in 20,338 women who gave birth .........................................................................83
7. Low birthweight (<2,500g) .......................................................................................................................83
8. Congenital anomalies ...............................................................................................................................83
9. Perinatal mortality rates (numbers of deaths in parentheses) .....................................................................83
10. Terminations of pregnancy ......................................................................................................................83
References .....................................................................................................................84
Publications ...................................................................................................................85
Annual Reports .............................................................................................................................................85
Other reports/papers ....................................................................................................................................85
1. Birth defects 85
2. Termination of pregnancy 88
3. Perinatal epidemiology 88
4. Perinatal mortality 91
5. Caesarean section 91
Appendix 1: Definitions ................................................................................................92
Appendix 2: 2013 Supplementary Birth Record Form .................................................96
Appendix 3: Congenital Abnormality Form ................................................................97
Pregnancy Outcome in South Australia 2013 page 5
Tables
Tables
Table 1: Births and crude birth rate by ASGS regions ................................................................................14
Table 2: Total births notified in 2013, by place of birth and plurality, South Australia ................................15
Table 3a: Hospital births by perinatal service delineation of hospital ...........................................................18
Table 3b: Hospital births by race and hospital .............................................................................................19
Table 4a: Race of women who gave birth ..................................................................................................21
Table 4b: Race and birthplace category of women who gave birth ............................................................21
Table 4c: Age and race of women who gave birth .....................................................................................22
Table 4d: Age-specific fertility rates ............................................................................................................23
Table 5a: Country of birth, major groups ...................................................................................................23
Table 5b: Specified country of birth ............................................................................................................23
Table 6a: Marital status and age ................................................................................................................25
Table 6b: Type of patient and marital status ...............................................................................................25
Table 7: Occupation of father and mother ................................................................................................26
Table 8a: Parity by race, women who gave birth ........................................................................................27
Table 8b: Previous pregnancy outcomes (multigravidae only) ......................................................................27
Table 9a: Gestation at first antenatal visit ...................................................................................................28
Table 9b: BMI of women who gave birth ....................................................................................................28
Table 9c: Antenatal visits by race, women who gave birth ..........................................................................29
Table 9d: Type of antenatal care .................................................................................................................29
Table 10a: Tobacco smoking status at first antenatal visit, non-Aboriginal and Aboriginal women ................30
Table 10b: Average number of tobacco cigarettes smoked per day in the second half of pregnancy,
non-Aboriginal and Aboriginal women .......................................................................................30
Table 11: Medical conditions in current pregnancy .....................................................................................31
Table 12: Frequency of some obstetric complications .................................................................................31
Table 13: Procedures performed in current pregnancy ................................................................................32
Table 14a: Onset of labour ...........................................................................................................................32
Table 14b: Method of induction of labour ....................................................................................................32
Table 14c: Augmentation of labour after spontaneous onset .......................................................................33
Table 15a: Method of birth ..........................................................................................................................34
Table 15b: Method of birth by presentation .................................................................................................35
Table 15c: Method of birth in breech presentation, by plurality ....................................................................35
Table 16: Frequency of some complications of labour and birth ..................................................................37
Table 17a: CTG performed during labour .....................................................................................................38
Pregnancy Outcome in South Australia 2013page 6
Tables
Table 17b: Fetal scalp pH taken during labour ..............................................................................................38
Table 18a: Analgesia for labour ....................................................................................................................38
Table 18b: Anaesthesia for birth ...................................................................................................................39
Table 19a: Postnatal length of stay by type of patient ..................................................................................39
Table 19b: Average postnatal length of stay by type of patient & type of birth .............................................39
Table 20: Sex of baby .................................................................................................................................40
Table 21: Birthweight distribution of all births ............................................................................................40
Table 22: Birth injuries ................................................................................................................................41
Table 23: Neonatal treatment given, all live births ......................................................................................41
Table 24: Level of nursery care utilised by birthweight, all live births ...........................................................41
Table 25: Length of stay of liveborn babies in hospital ................................................................................42
Table 26: Selected congenital abnormalities notified to the perinatal statistics collection ............................43
Table 27a: Birthweight by plurality ...............................................................................................................44
Table 27b: Gestation at birth by plurality ......................................................................................................44
Table 27c: Perinatal outcome by plurality .....................................................................................................44
Table 28a: Perinatal mortality by birthweight ...............................................................................................45
Table 28b: Perinatal mortality by gestational age at birth ..............................................................................46
Table 28c: Perinatal mortality (all births of specified birthweight/gestation) ..................................................46
Table 28d: Perinatal mortality by race, all births ............................................................................................47
Table 29: Planned home births by age of women .......................................................................................47
Table 30: Method of birth in planned home births .....................................................................................48
Table 31: Birthweight distribution of planned home births .........................................................................48
Table 32: Perinatal outcome in planned home births ..................................................................................48
Table 33: Planned birthing unit births by age of women .............................................................................49
Table 34: Method of birth in planned birthing unit births ...........................................................................49
Table 35: Birthweight distribution of planned birthing unit births ...............................................................50
Table 36: Perinatal outcome in planned birthing unit births ........................................................................50
Table 37: Termination of pregnancy rate per 1,000 women aged 15-44 years, 1970-2013 .........................51
Table 38: Terminations of pregnancy by age ...............................................................................................52
Table 39: Termination of pregnancy and live birth rates and termination of pregnancy proportions by age,
South Australia, 2013 .................................................................................................................53
Table 40: Terminations by place of residence ..............................................................................................54
Table 41: Terminations by hospital category ...............................................................................................54
Table 42: Terminations by category of doctor .............................................................................................55
Table 43: Reason for termination for fetal reasons ......................................................................................55
Pregnancy Outcome in South Australia 2013 page 7
Tables
Table 44a: Women with previous terminations by age..................................................................................56
Table 44b: Calculation of total induced abortion rate (TAR) ..........................................................................56
Table 45a: Women with previous terminations by age..................................................................................57
Table 45b: Calculation of total induced abortion rate (TAR) ..........................................................................58
Table 45c: Calculation of total first induced abortion rate (TFAR) .................................................................58
Table 46: Obstetric profiles by hospital category, South Australia, 2013: live births and stillbirths
of >=400g or >=20 weeks gestation ...........................................................................................61
Table 47: Socio-demographic aspects of perinatal statistics, 1981 and 2003 2013 ...................................77
Table 48: Obstetric aspects of perinatal statistics, 1981 and 2002 2013 ...................................................78
Figures
Figure 1a: Map showing SA hospitals with obstetric beds in 2013 ...............................................................16
Figure 1b: Map showing Central Regions of SA ...........................................................................................17
Figure 2: Distribution of hospital births by hospital category ......................................................................18
Figure 3: Age and race of women who gave birth .....................................................................................22
Figure 4: Reasons for induction of labour ..................................................................................................33
Figure 5a: Method of birth, women who gave birth ....................................................................................34
Figure 5b: Reason for caesarean section ......................................................................................................36
Figure 5c: Reason for elective caesarean section ..........................................................................................36
Figure 5d: Reason for emergency caesarean section ....................................................................................37
Figure 6: Perinatal mortality rate by birthweight, all births .........................................................................45
Figure 7: Termination of pregnancy rate in South Australia, 1970-2013 .....................................................51
Figure 8a: Termination of pregnancy and live births by age ..........................................................................53
Figure 8b: Teenage pregnancy, termination of pregnancy and birth rates, South Australia, 1970-2013 ........54
Figure 9: Percentage of Aboriginal women by hospital category ................................................................62
Figure 10: Percentage of women with <7 antenatal visits by hospital category .............................................62
Figure 11: Percentage of teenage women by hospital category ....................................................................62
Figure 12: Percentage of women 35 years or more by hospital category ......................................................63
Figure 13: Percentage of single women by hospital category .......................................................................63
Figure 14: Percentage of women with 4 or more prior livebirths by hospital category ..................................63
Figure 15: Percentage of women with 1 or more prior perinatal deaths by hospital category .......................64
Figure 16: Percentage of women with obstetric complications by hospital category .....................................64
Figure 17: Percentage of women with complications during labour or birth by hospital category ................64
Figure 18: Percentage of women with induction of labour by hospital category ...........................................65
Pregnancy Outcome in South Australia 2013page 8
Figures
Figure 19: Percentage of women having epidural analgesia by hospital category .........................................65
Figure 20: Percentage of breech births by hospital category .........................................................................65
Figure 21: Percentage of emergency caesarean sections by hospital category ...............................................66
Figure 22: Percentage of elective caesarean sections by hospital category ....................................................66
Figure 23: Percentage of total caesarean sections by hospital category ........................................................66
Figure 24: Percentage of births with birthweight below 2,500g by hospital category ...................................66
Figure 25: Percentage of births with gestation less than 37 weeks by hospital category ...............................67
Figure 26: Percentage of births with prolonged hospitalisation by hospital category .....................................67
Figure 27: Percentage of live births requiring neonatal intensive care by hospital category ...........................67
Figure 28: Percentage of births with birth defects by hospital category ........................................................67
Figure 29a: Induction of labour for selected primiparae, SA hospitals with >=550 births per year ..................73
Figure 29b: Caesarean section rate for selected primiparae, SA hospitals with >=550 births per year .............73
Figure 29c: VBAC: Proportion of women who had a vaginal birth following a previous primary (first) caesarean
section & no intervening births, SA hospitals with >=550 births per year .....................................74
Figure 29d: Proportion of selected primiparae with an intact perineum after a vaginal birth, SA hospitals with
>=550 births per year .................................................................................................................74
Figure 29e: TERM NICU: proportion of term babies admitted to NICU for reasons other than congenital
abnormality, SA hospitals with >=550 births per year ..................................................................74
Figure 29f: SPMR (Standardized Perinatal Mortality Ratio) for all births, SA hospitals with >=550 births
per year,......................................................................................................................................75
Figure 29g: SPMR (Standardized Perinatal Mortality Ratio) for all births, SA hospitals with >=550 births
per year, 2008-2013 ...................................................................................................................75
Figure 30.1: Percentage of teenage women among women giving birth in SA ..............................................79
Figure 30.2: Percentage of women aged 35 years and over among women giving birth in SA .......................79
Figure 30.3: Percentage of primiparous women aged 35 years and over in SA ..............................................79
Figure 30.4: Percentage of Aboriginal women and Asian women among women giving birth in SA ..............80
Figure 30.5: Percentage of women never married and with no de facto partner among women giving
birth in SA ..................................................................................................................................80
Figure 30.6: Percentage of multiple births among births in SA ......................................................................80
Figure 30.7 Percentage of low birthweight babies among births in SA ...........................................................81
Figure 30.8: SA standardised perinatal mortality ratio (SPMR)........................................................................81
Pregnancy Outcome in South Australia 2013 page 9
Figures
Executive Summary
This report on Pregnancy Outcome in South Australia for 2013 provides statistics derived mainly from the South
Australian perinatal statistics collection of births. These are notified by hospital and homebirth midwives and neonatal
nurses. For a more complete picture of pregnancy outcome, some statistics from the abortion statistics collection
are also included. More statistics on abortions in the state in 2013 are available in the Eleventh Annual Report of the
Abortion Reporting Committee. Comparisons of selected pregnancy characteristics and outcomes are provided for
six different hospital categories in the state. Individual hospital reports (Pregnancy and Neonatal Care Bulletins) with
these comparisons made in greater detail are provided to hospitals in the state with at least 100 births per year. Group
reports are provided for hospitals with smaller numbers of births. Comparisons of maternity performance indicators
are also provided for hospitals with at least 550 births per year.
1. Numbers and fertility rates
The number of births notified in South Australia in 2013 was 20,263, which was 403 less than the previous year. The
number of women who gave birth was 19,925. The total fertility rate was 1.85 live births per woman, lower when
compared with that of 2012 which was 1.91.The 2012 rate was the same as in 2007 and 2008 and represented the
highest rate in the past decade.
2. Place of birth
Compared to 2012, the numbers of births increased at all metropolitan teaching hospitals. Births increased at one of
the metropolitan private hospitals while they decreased at three with one remaining steady. 1,291women (6.4%) gave
birth in birthing units in teaching hospitals and 107(0.6%) had planned home births.
3. Teenage women
666 teenage women gave birth, accounting for 3.3% of women who gave birth, and 622 teenage women had
terminations of pregnancy, accounting for 13.3% of terminations. In 2013, the proportion of known pregnancies
terminated was 48% for teenagers compared with 19% for women of all ages. The teenage pregnancy rate declined
in the 1970s and 1980s, but increased in the early 1990s. It declined again after 1996. The teenage pregnancy rate in
2013 of 25.3 per 1,000 women aged 15-19 years, was the lowest rate recorded since 1970.
4. Older women and first time mothers
The mean age of women giving birth increased from 26.6 years in 1981 to 29.8 years in 2013, and, among first time
mothers, from 24.4 years to 28.2 years. The proportion of women aged 35 years or more increased from 4.6% in
1981 to a high of 21.1% in 2009 and was 19.8% in 2013. Among first time mothers, this proportion increased from
1.2% to 12.8% in 2009 and was 12.4% in 2013. As in the previous decade, more women gave birth in the 30-34
years than in the 25-29 years age group.
5. Country of birth and race
Seventy-seven percent of women who gave birth in 2013 were Australian-born. Of women born overseas who
gave birth, the largest proportions came from India (4% of women), the United Kingdom and Ireland (2.5%), China
(2.2%), Vietnam (1.2%), the Philippines (1.%), New Zealand (0.9%) and Sudan (0.7%), Afghanistan (0.6%), Pakistan
(0.5%) and Cambodia and Malaysia (0.4%). Of the women who gave birth in the state in 2013, 12.0% (2,394
women) were Asian, compared with 2% in 1981. They gave birth mainly in teaching hospitals.
6. Smoking during pregnancy and Body Mass Index
The proportion of women smoking at the first antenatal visit has declined steadily from 25% in 1998 to 11.1% in
2013. Additionally 3.3% of women had quit smoking before the first antenatal visit.
Statistics on Body Mass Index were available for 81% of women who gave birth in 2013 (an improvement from 42%
in 2007), and show that 42.3% of all women giving birth were overweight, including 11.3% classified as obese and
8.2% severely or morbidly obese.
Pregnancy Outcome in South Australia 2013page 10
Executive Summary
7. Antenatal care and length of stay
Week of gestation at the first antenatal visit was reported for 95% of women who gave birth, and show that 81%
of these women attended for antenatal care within the first 14 weeks of pregnancy. Ninety-nine percent of women
attended at least one antenatal visit. Of those women for whom the number of antenatal visits was reported, 91%
of women attended seven or more antenatal visits. Although many women had more than one type of antenatal
care, the most common types used were hospital clinics (42%), obstetricians in private practice (27%) and general
practitioners (22.3%). Twenty-seven percent of women were private patients. The median length of stay of women
after a birth was three days; it was two days for those who had a vaginal birth and four days for those who had a
caesarean section. It was both two days longer among private patients for vaginal births and for caesarean births.
8. Aboriginal women and babies
717 Aboriginal women gave birth in South Australia in 2013, accounting for 3.6% of all women who gave birth in
the state. Fourteen percent of Aboriginal women were teenagers (compared with 2.9% of non-Aboriginal women).
Of the Aboriginal women for whom week of gestation at the first antenatal visit was reported, 53% attended for
antenatal care within the first 14 weeks of pregnancy (compared with 82% of non-Aboriginal women). Of the
Aboriginal women for whom the number of antenatal visits was reported, 67% attended at least seven antenatal
visits during pregnancy (compared with 89% of non-Aboriginal women). In 2013, at the first antenatal visit, 45% of
Aboriginal women reported that they smoked, compared with 49% in 2012, while in non-Aboriginal women this
proportion was 9.8%. In 2013, the proportion of preterm births (<37 weeks gestation) was 18% among babies of
Aboriginal women compared with 9.5% among babies of non-Aboriginal women. Among live born babies (excluding
terminations of pregnancy), the proportions of low birthweight babies (<2,500g) were 14.8% and 6.9% respectively.
The perinatal mortality rate of babies of Aboriginal women was 15.1 per 1,000 births in 2013 compared with 8.8 per
1,000 births for births to non-Aboriginal women.
For the first time in 2012, the Indigenous status of the baby was also collected independently of the mother. There
were 952 Indigenous babies, representing 4.8% of all babies born in 2013. They comprised 904 (95%) Aboriginal, 17
(1.8%) Torres Strait Islander and 31 (3.3%) Aboriginal and Torres Strait Islander.
9. Procedures
Ninety-eight percent of women who gave birth had an ultrasound examination; 33% had labour induced while
another 18% had spontaneous labour augmented; epidurals were used for pain relief during labour for 31% of
women, and 13% had an episiotomy (20% of women who gave birth vaginally). The main reasons for induction of
labour were prolonged pregnancy (17%), hypertension (15%), diabetes or gestational diabetes (9.5%), poor fetal
growth (8%) and premature rupture of membranes (9.5%). Forty-five percent of inductions of labour were performed
for other than defined indications.
10. Method of birth
Fifty-four percent of women had normal spontaneous vaginal births. Six percent gave birth by ventouse and another
5.6% by forceps (compared with 1% and 15% respectively in 1981). In 2013 the proportion of women giving birth
by caesarean section was 34%, a proportion which has been relatively stable for several years. Of those who had
previously given birth, 31% had previously had a caesarean section. Only 15.6% of women had a vaginal birth
following a previous first caesarean without intervening births, compared with 30% in 1998. The main reasons
given for caesarean section were previous caesarean section (36%), failure to progress in labour or cephalopelvic
disproportion (27%), fetal distress (15%) and malpresentation (11%).
11. Multiple births
Multiple births accounted for 3.3% of births; women with twins or triplets accounted for 1.6% of women who gave
birth in 2013. These proportions increased in the 1980s and 1990s as a result of the use of assisted conception and
the increasing proportion of older women, who have higher rates of multiple pregnancies than younger women. The
peak proportion of multiple births was recorded in 2002 and 2003 (3.6%). The subsequent decline in the proportion
of multiple births was probably related to the increasing use of single embryo transfer in assisted conception practice.
Pregnancy Outcome in South Australia 2013 page 11
Executive Summary
12. Abortions
4,681 terminations of pregnancy were notified, 84 fewer than in 2012. The induced abortion rate was 14.4 per
1,000 women aged 15-44 years, compared with 14.7 per 1,000 women aged 15-44 years in 2012. It has declined
significantly since 2001, when it was 17.7 per 1,000 women. Approximately 97% of terminations were performed
in metropolitan public hospitals, including the Pregnancy Advisory Centre, and 77% were performed by doctors
in family advisory clinics in these hospitals. Ninety-one percent of terminations were performed within the first 14
weeks of pregnancy and 2.0% (94) were performed at or after 20 weeks gestation. Fifty percent of terminations
performed at or after 20 weeks gestation were for fetal reasons. Approximately 19% of reported pregnancies ended
as terminations in 2013.
13. Perinatal mortality
The perinatal mortality rate for all births in 2013 was 9.0 per 1,000 births, the stillbirth rate 6.8 per 1,000 births and
the neonatal mortality rate 2.2 per 1,000 live births. For international comparison, the World Health Organisation
recommends including only stillbirths of at least 1,000g birthweight (or 28 weeks gestation if birthweight unavailable)
and early neonatal deaths within the first 7 days of life (instead of 28 days) in calculating the perinatal mortality rate.
This rate for international comparison for South Australia for 2013 was 2.3 per 1,000 births, with an early neonatal
mortality rate of 0.5per 1,000 live births.
Pregnancy Outcome in South Australia 2013page 12
Executive Summary
I. Introduction
This report summarises the statistics for 2013 from the South Australian Perinatal Statistics Collection and the South
Australian Abortion Statistics Collection, both of which are held in the Pregnancy Outcome Unit. Some definitions
used by the Unit are provided in Appendix 1. Guidelines1 with some of these definitions are issued to all South
Australian obstetric units to promote the uniform completion of forms.
1. The Perinatal Statistics Collection
This collection utilises notifications of births in South Australia made by hospital and homebirth midwives and hospital
neonatal nurses on the Supplementary Birth Record Form (SBR - Appendix 2). The SBRs are checked manually for
completeness and data discrepancies and then go through a series of automated validation procedures during data
entry.1
Information on congenital abnormalities detected at birth or in the neonatal period (within 28 days of birth) is
provided by doctors using the Congenital Abnormality Form (Appendix 3). Few statistics on birth defects are included
in this report as these are reported annually by the South Australian Birth Defects Register at the Women s and
Children s Hospital.2 The Register complements statistics on birth defects from the perinatal and abortion statistics
collections with statistics on birth defects detected and notified after discharge from the birth hospital up to the
child s fifth birthday.
Perinatal data are provided under legislation, the South Australian Health Care Regulations 2008, Part 5 Pregnancy
outcome data and statistics. The South Australian Perinatal Statistics Collection includes all births occurring in South
Australia, including those to women who normally reside interstate, mainly in New South Wales near the South
Australian border and in the Northern Territory. Births of South Australian residents which occur in other states are not
included. The perinatal data have been collected since 1981, but there have been changes in the data items collected
over the years.
Perinatal death certificates are obtained from the Births, Deaths and Marriages Registration Division, chromosome
analysis reports from the Genetics and Molecular Pathology Directorate at Women s and Children s Hospital, autopsy
reports from pathology departments and Coroner s autopsy reports and findings from the Coroner s Office. All these
are linked with the SBRs to provide more complete information on births and deaths. All maternal, perinatal and
infant deaths in the state are reviewed by the Maternal, Perinatal and Infant Mortality Committee and details of
these are reported in the annual report of the Committee entitled Maternal, Perinatal and Infant Mortality in South
Australia 2013. 3
2. The Abortion Statistics Collection
Notifications made by doctors of medical terminations of pregnancy under the Criminal Law Consolidation (Medical
Termination of Pregnancy) Regulations 2012, are included in this collection. This collection commenced in 1970, when
specific abortion legislation was introduced under the Criminal Law Consolidation Act. Termination of pregnancy
became legal in the state if performed in a prescribed hospital by a medical practitioner for a woman who has been
resident at least two months in the state. The practitioner and another medical practitioner must have examined
the woman and formed the opinion that the continuation of the pregnancy would involve greater risk to her life
or greater risk of injury to her physical or mental health than if the pregnancy were terminated; or that there is a
substantial risk that if the pregnancy were not terminated and the child were born, the child would suffer from
such physical or mental abnormalities as to be seriously handicapped. A termination may not be performed on a
woman who is pregnant with a child capable of being born alive unless it is performed to save the woman s life.
The legislation states that evidence that a woman has been pregnant for a period of 28 weeks or more is prima facie
proof that she was pregnant with a child that was capable of being born alive.
Pregnancy Outcome in South Australia 2013 page 13
Introduction
II. Mothers and Babies: Characteristics & Outcomes
The births in 2013 in South Australia described in this report include live births, stillbirths and terminations of
pregnancy of at least 400g birthweight or 20 weeks gestation. Fifty births of less than 400g birthweight have been
included, consisting of 45 stillbirths and five live births. The five live births were born at 20-28 weeks gestation and all
died in the neonatal period. SBRs were received for all 20,263 births reported by hospital and home birth midwives
in their monthly notification lists. These comprised 20,125 live births and 138 stillbirths. The number of women who
gave birth was 19,925, 413 less women than in 2012. Findings relating to Aboriginal women and babies in the text of
this report have been italicised for easy identification, in accordance with the request of the Aboriginal Health Council
of South Australia.
1. Place of residence of mother
This table uses the ABS Statistical Geographical Boundaries (ASGS 2013), with SA4 boundaries for the four Adelaide
Metropolitan Regions, and SA3 boundaries to present the nine non metropolitan components in South Australia. The
distribution of births according to the mother s place of residence by these Regions is provided in Table 1 together
with the estimated resident population and crude birth rate. The crude birth rate in 2013 for South Australia was 12
per 1,000 population. It was lowest in the Fleurieu Kangaroo Island, and Adelaide-Central and Hills regions. It was
highest in the Adelaide - North Region and was also high in Eyre Peninsula and South West, and Outback North and
East Regions.
Table 1: Births and crude birth rate by ABS Statistical Geographical Boundaries (ASGS 2013) regions,
South Australia, 2013
ASGS 2013
(Mother s residence)
Total births Live births
Estimated resident
population, June
30, 2013+
Crude birth
rate per 1,000
population
Number Percent Number Number
Adelaide - Central and Hills 2,920 14.4 2,894 292,814 9.9
Adelaide - North 6,068 29.9 6,037 413,356 14.6
Adelaide - South 4,112 20.3 4,077 356,282 11.4
Adelaide - West 2,682 13.2 2,664 229,214 11.6
Barossa 367 1.8 367 34,308 10.7
Lower North 237 1.2 233 22,535 10.3
Mid North 299 1.5 296 27,510 10.8
Yorke Peninsula 250 1.2 249 24,835 10.0
Eyre Peninsula and South West 790 3.9 787 58,169 13.5
Outback - North and East 377 1.9 375 29,534 12.7
Fleurieu - Kangaroo Island 401 2.0 401 48,572 8.3
Limestone Coast 777 3.8 772 64,703 11.9
Murray and Mallee 809 4.0 804 68,995 11.7
Interstate 174 0.9 169 na na
Total 20,263 100.0 20,125 1,670,827 12.0
+ Australian Bureau of Statistics. Population estimates by age and sex, South Australia, 2013. Canberra: ABS, 2013
(Catalogue No 3235.0).
na: not applicable
Pregnancy Outcome in South Australia 2013page 14
Mothers and Babies
2. Place of birth of baby
Of the 20,263 births in 2013, 114 (0.6%) were home births and of those, 107 were planned homebirths. The
remaining 20,149 births occurred in hospitals or in 91cases, before arrival at hospitals into which the women had
been booked. These 91 Born Before Arrival (BBA) births have been included in the statistics for those hospitals.
The distribution of births by place of birth (home or hospital) and plurality is provided in Table 2. Locations of South
Australian hospitals with obstetric beds in 2013 are provided in Figures 1a and 1b.
Table 2: Total births notified in 2013, by place of birth and plurality, South Australia
Condition at
birth
Home births Hospital births
Total
Singleton Twin Singleton Twin Triplet
Live birth 114 - 19,348 636 27 20,125
Stillbirth 0 - 134 4 0 138
Total births 114 - 19,482 640 27 20,263
Of the 20,149 hospital births, 80.5% occurred in metropolitan hospitals (teaching and private) and 19.5% in country
hospitals. This distribution is summarised in Table 3a and Figure 2. Table 3b provides the numbers of births and
women by race in individual hospitals. Metropolitan hospitals are listed in order of number of births and country
hospitals in alphabetic order within their Perinatal Service Delineation and category of number of births. Fifty-eight
percent of hospital births in South Australia in 2013 occurred in metropolitan teaching hospitals. Maternity and
neonatal services at SA hospitals are delineated according to six levels of service, as defined in the policy, Standards
for Maternal and Neonatal Services in SA, 2010 .4 The Women s and Children s Hospital is defined as providing Level
5 maternity services and Level 6 neonatal services, as it provides a high risk pregnancy service and neonatal intensive
care, but has no maternity intensive care facility on site. The Lyell McEwin Hospital provides Level 6 maternity services
and Level 5 neonatal services with maternity intensive care services and special care neonatal services. Flinders Medical
Centre provides Level 6 maternity and neonatal services with both maternity and neonatal intensive care services. All
the metropolitan private maternity hospitals have special care nurseries, as do Mt Gambier and Port Augusta hospitals.
Compared with 2012, the total number of births decreased overall at the three metropolitan teaching hospitals.
The total number of births in metropolitan private hospitals also decreased. Ashford and North Eastern Community
showed an increase, whilst small decreases were seen at Burnside, Calvary and Flinders Private.
The total number of births in country hospitals decreased slightly. In the Level 4:4 country centres, births decreased
at Mount Gambier, while births at Port Augusta increased. Increases also occurred at the majority of hospitals with
more than 100 births per year, e.g. Gawler Health Service, Loxton, Mount Barker Murray Bridge, Naracoorte and
the Northern Yorke Peninsula Regional Health Service (Wallaroo). Small decreases were seen at Riverland General
Hospital (Berri), Port Lincoln, Barossa Health (Tanunda), and Whyalla. At smaller country centres with <100 births per
year, births increased only at Waikerie. Decreases were seen at Lower North Health Centre (Clare), Mid North Health
(Jamestown), Kangaroo Island, Millicent, South Coast District (Victor Harbor) and Southern Flinders Health (Crystal
Brook). Numbers remained relatively constant at Ceduna and Kapunda.
Pregnancy Outcome in South Australia 2013 page 15
Mothers and Babies
Figure 1a: South Australian hospitals with obstetric beds in 2013
V
(!
(!
(!
(!
(!
(!
(!
(!
(!
!
!
!
!
!
!
!
!
OUTBACK - NORTH AND EAST
EYRE PENINSULA
AND SOUTH WEST
MURRAY
AND MALLEE
LIMESTONE COAST
MID NORTH
LOWER NORTH
YORKE PENINSULA
FLEURIEU - KANGAROO ISLAND
Quorn
Clare
Berri
Ceduna
Loxton
Whyalla
Wallaroo Waikerie
Jamestown
Millicent
Kingscote
Port Pirie
Naracoorte
Port Lincoln
Port Augusta
Mount Gambier
Murray Bridge
Crystal Brook
0 150 30075
Kilometres
" > 2000 births per annum
# 1000-2000 births per annum
V 450 - 999 births per annum
(! 100 - 449 births per annum
! < 100 births per annum
See Figure 1b for
Central Regions
Pregnancy Outcome in South Australia 2013page 16
Mothers and Babies
Figure 1b: Hospitals with obstetric beds in 2013, Central Region of SA
"
""
"
#
#
V
V
V
V
(!
(!
(!
!
!
ADELAIDE - NORTH
ADELAIDE - SOUTH
Kapunda
Gawler Health Service
Lyell McEwin
FMC
Tanunda
W&CH
SCDH
(Victor Harbor)
Ashford
BWMH
Calvary
Flinders Private
Mt Barker
NECH
FLEURIEU - KANGAROO ISLAND
BAROSSA
ADELAIDE - CENTRAL
AND HILLS
ADELAIDE - WEST
0 10 205
Kilometres
" > 2000 births per annum
# 1000-2000 births per annum
V 450 - 999 births per annum
(! 100 - 449 births per annum
! < 100 births per annum
Pregnancy Outcome in South Australia 2013 page 17
Mothers and Babies
Table 3a: Hospital births by Perinatal Service Delineation, South Australia, 2013
Hospital category Number of births Percent hospital births
Metropolitan teaching 11,609 57.6
Women s & Children s Hospital (W&CH) (4,891) (24.3)
Flinders Medical Centre (FMC) (3,384) (16.8)
Lyell McEwin Hospital (LMH) (3,333) (16.5)
Metropolitan private 4,622 22.9
Country 3,918 19.5
Level 4:4 (860) 4.3
Level 3:3>100 births per annum (2,595) 12.9
Level 3:3<100 births per annum (453) 2.3
Other Country (10) 0.0
Total 20,149 100.0
Figure 2: Distribution of hospital births by hospital category, South Australia, 2013 (n=20,149)
b
16.8%
0 10 20 30 40 50 60 70
Percentage of hospital births
19.5%
22.9%
57.6%
a Ashford 7.2%
b Burnside 5.8%
c Calvary 3.9%
d Flinders Private 2.6%
e North Eastern Community 3.4%
r Mt Gambier 2.8%
s Port Augusta 1.5%
t Gawler 2.8%
u Mount Barker 1.9%
v Port Lincoln 1.5%
w Murray Bridge 1.2%
x Whyalla 1.3%
y Other country hospitals with >100 births per year 4.2%
z Hospitals with <100 births per year 2.3%
W&CH LMHFMC
e
u v w
24.3% 16.5%
a c
r s x y zt
d
Pregnancy Outcome in South Australia 2013page 18
Mothers and Babies
Table 3b: Hospital births in South Australia in 2013 by race and hospital*
Hospital Caucasian Aboriginal Asian Other
Total
births
Total number
of women who
gave birth
Metropolitan teaching
Women s & Children s Hospital (W&CH) 2,879 213 1,273 526 4,891 4,740
Flinders Medical Centre (FMC) 2,748 98 319 219 3,384 3,322
Lyell McEwin Hospital (LMH) 2,457 148 423 305 3,333 3,298
Royal Adelaide Hospital (RAH) 1 0 0 0 1 1
Total 8,085 459 2,015 1,050 11,609 11,361
Metropolitan private
Ashford 1,300 4 122 28 1,454 1,422
Burnside War Memorial (BWMH) 1,071 0 79 15 1,165 1,145
Calvary 708 5 56 11 780 770
Flinders Private 506 1 18 10 535 528
North Eastern Community (NECH) 639 0 30 19 688 678
Total 4,224 10 305 83 4,622 4,543
Country
Level 4:4* Country
Mt. Gambier 502 15 18 17 552 549
Pt Augusta 205 87 4 12 308 303
Subtotal 707 102 22 29 860 852
Level 3:3* Country ?100 births
Barossa Health (Tanunda Centre) 111 1 4 2 118 118
Gawler Health Service 542 15 10 3 570 570
Loxton District 101 5 1 0 107 107
Mt. Barker 354 5 9 5 373 373
Murray Bridge Soldiers Memorial 196 21 13 7 237 237
Naracoorte 157 2 5 9 173 172
Northern Yorke Peninsula Regional
Health Service (Wallaroo)
137 10 2 0 149 149
Pt. Lincoln 264 18 7 4 293 293
Pt. Pirie 122 14 2 5 143 143
Riverland Regional (Berri) 139 10 12 7 168 167
Whyalla 209 29 9 17 264 263
Subtotal 2,332 130 74 59 2,595 2,592
* Perinatal Service Delineation see text for further explanation.
This is a metropolitan hospital situated at the metropolitan/country boundary; it has the characteristics of a country hospital and has been included as such.
Pregnancy Outcome in South Australia 2013 page 19
Mothers and Babies
Table 3b continued
Hospital Caucasian Aboriginal Asian Other
Total
births
Total women
who gave birth
Level 3:3* Country <100 births
1-99 births per annum
Ceduna 30 12 0 2 44 44
Kangaroo Island 31 2 1 2 36 36
Kapunda 46 0 0 0 46 46
Lower North Health Centre (Clare) 78 1 2 1 82 82
Mid North Health (Jamestown) 42 2 0 0 44 44
Millicent 15 2 0 1 18 18
South Coast District (Victor Harbor) 91 1 0 2 94 94
Southern Flinders Health Service
(Crystal Brook)
34 1 0 0 35 35
Waikerie 47 2 1 4 54 54
Subtotal 414 23 4 12 453 453
Other Country
Cowell District 1 0 0 0 1 1
Marla 0 1 0 0 1 1
Pinnaroo Soldiers Memorial 0 0 0 1 1 1
Pitjantjatjara Homelands 0 1 0 0 1 1
Quorn 3 0 0 0 3 3
Southern Yorke Peninsula (Yorketown) 1 0 0 0 1 1
Streaky Bay Public 1 1 0 0 2 2
Subtotal 6 3 0 1 10 10
Total (country) 3,459 258 100 101 3,918 3,907
Grand total 15,768 727 2,420 1,234 20,149 19,811
* Perinatal Service Delineation see text for further explanation
3. Maternal and baby race
The distribution of women who gave birth, by race is provided in Table 4a and also by category of birthplace in Table
4b. In these tables and all others where distribution by race is shown, Aboriginal includes Aboriginal (685 women),
Torres Strait Islander (14 women) and those who are Aboriginal and Torres Strait Islander (18 women). Aboriginal
women accounted for 3.6% of women and gave birth mainly in metropolitan teaching hospitals and country
hospitals. Asian women accounted for 12% of women, and gave birth mainly in metropolitan teaching hospitals, but
12.7% gave birth in private hospitals.
For the first time in 2012, the Indigenous status of the baby was also collected independently of the mother. In 2013
there were 952 Indigenous babies, representing 4.8% of all babies born. They comprised 904 (95%) Aboriginal, 17
(1.8%) Torres Strait Islander and 31 (3.3%) Aboriginal and Torres Strait Islander.
Pregnancy Outcome in South Australia 2013page 20
Mothers and Babies
Table 4a: Race of women who gave birth, South Australia, 2013
Race Number of women % Women
Caucasian 15,600 78.3
Aboriginal 717 3.6
Asian 2,394 12.0
Other 1,214 6.1
Total 19,925 100.0
Table 4b: Table 4b: Race and birthplace category of women who gave birth, South Australia, 2013
Birthplace
Race of women
TotalCaucasian Aboriginal Asian Other
Number % Number % Number % Number % Number %
Metropolitan
teaching hospital
7,895 50.6 449 62.6 1,988 83.0 1,029 84.8 11,361 57.0
Metropolitan
private hospital
4,147 26.6 9 1.3 304 12.7 83 6.8 4,543 22.8
Country hospital 3,449 22.1 257 35.8 100 4.2 101 8.3 3,907 19.6
Home 109 0.7 2 0.3 2 0.1 1 0.1 114 0.6
Total 15,600 (78.3) 717 (3.6) 2,394 (12.0) 1,214 (6.1) 19,925 100.0
4. Maternal age
Among the five-year age groups, the largest number of women who gave birth was in the 30-34 years age group
(Table 4c). The proportion of women in this age group (33%) has exceeded that of the 25-29 years age group
(29.4%) since 2001. Teenage women accounted for 3.3% of women who gave birth and older women aged 35 years
or more accounted for 19.8% (Table 4c and Figure 3). Aboriginal women were generally younger than non-Aboriginal
women: 13.5% were teenagers and only 7.8% were 35 years or older. Among Asian women, on the other hand, only
0.7% were teenagers but 19.4% were 35 years or older.
The age-specific fertility rates have remained steady in the 20-24, 30-34,35-39 and 40+ age groups and decreased
in the 15-19 and 25-29 groups, when compared with 2012 (Table 4d). The rate was highest in the age group 30-34
years (124.7 per 1,000 women), followed by the 25-29 years age group (104.5 per 1,000 women). The general
fertility rate (see Appendix 1) was 61.7 per 1,000 women aged 15-44 years, down from 63.1 in 2012. The total
fertility rate (see Appendix 1) was 1.85 live births per woman, lower than 2012 which at 1.91 was the same as 2008
the highest for more than a decade, but still below replacement level (2.1).
Pregnancy Outcome in South Australia 2013 page 21
Mothers and Babies
Table 4c: Age and race of women who gave birth, South Australia, 2013
Age
(years)
Caucasian Aboriginal Asian Other Total
Number % Number % Number % Number % Number %
<15 3 0.0 5 0.7 0 0.0 2 0.2 10 0.0
15-19 515 3.3 92 12.8 17 0.7 32 2.6 656 3.3
20-24 2,232 14.3 263 36.7 176 7.4 210 17.3 2,881 14.5
25-29 4,478 28.7 213 29.7 793 33.1 374 30.8 5,858 29.4
30-34 5,152 33.0 88 12.3 945 39.5 391 32.2 6,576 33.0
35-39 2,546 16.3 46 6.4 390 16.3 176 14.5 3,158 15.9
40-44 648 4.2 10 1.4 71 3.0 28 2.3 757 3.8
45+ 26 0.2 0 0.0 2 0.1 1 0.1 29 0.1
Total 15,600 (78.3) 717 (3.6) 2,394 (12.0) 1,214 (6.1) 19,925 100.0
Figure 3: Age and race of women who gave birth, 2013 (n=19,925)
0%
20%
40%
60%
80%
100%
Caucasian
n=15,600
Aboriginal
n=717
Asian
n=2,394
Other
n=1,214
Total
n=19,925
Pe
rc
en
ta
g
e
o
f
w
o
m
en
14-19 20-24 25-29 30-34 35+ Age (years)
Pregnancy Outcome in South Australia 2013page 22
Mothers and Babies
Table 4d: Age specific fertility rates (ASFR), South Australia, 2013
Age
(years) Number of live births
Estimated resident
female population*
Age-specific fertility rate per
1,000 women (ASFR)
<15 10 na na
15-19 656 50,918 13.1
20-24 2,897 55,868 51.9
25-29 5,900 56,460 104.5
30-34 6,650 53,325 124.7
35-39 3,204 51,246 62.5
40-44 772 58,198 13.8
45+ 31 na na
Total 20,110 326,015 61.7
* Australian Bureau of Statistics. Population Estimates by Age and Sex, South Australia 2013. Canberra: ABS, 2013 (Catalogue No 3235.0).
# the number of live births and fertility rate for women aged 15-19 years include live births for younger ages, and the number and rate for women
aged 40-44 years include live births for older ages, while the total number and rate (general fertility rate) include all live births. Live births in this table
exclude terminations of pregnancy.
Sum of 5-year ASFRs = 370.5 per 1,000 women. Total fertility rate = 369.7 x 5 = 1,852.3 live births per 1,000 women = 1.85 live births per woman.
5. Country of birth
The distribution of women by country of birth is provided in Table 5a by major group, and in Table 5b by specified
countries of birth that had 40 or more women who gave birth. Of the 24.4% of women born outside Australia, the
largest proportion was born in India (4% of women). Other countries contributing relatively large proportions of
migrant women were the United Kingdom and Ireland (2.5%), China (2.2%), Vietnam (1.2%) the Philippines (1%),
New Zealand (0.9%), Sudan, (0.7%), Afghanistan (0.6%), Malaysia (0.6%), Pakistan (0.5%), Bangladesh, Cambodia,
Iran, Sri Lanka, South Africa, Thailand and the United States of America (0.4% each), Congo, Indonesia, Iraq, Japan,
Nepal and Poland, (0.3% each), and Burundi, Canada, Germany and Myanmar (Burma) (0.2% each).
Table 5a: Country of birth, major groups,* women who gave birth, South Australia, 2013
Country of birth Number %
1 Oceania and Antarctica 15,280 76.7
2 Europe and the USSR 933 4.7
3 The Middle East and North Africa 392 2.0
4 Southeast Asia 841 4.2
5 Northeast Asia 619 3.1
6 Southern Asia 1,247 6.3
7 Northern America 118 0.6
8 South America, Central America and the Caribbean 116 0.6
9 Africa (excluding North Africa) 378 1.9
Unknown 1 0.0
Total 19,925 100.0
* Australian Bureau of Statistics. Australian Standard Classification of Countries for Social Statistics (ASCCSS). Canberra: ABS, 1990 (Catalogue No
1269.0).
Pregnancy Outcome in South Australia 2013 page 23
Mothers and Babies
Table 5b: Specified country of birth,* women who gave birth, South Australia, 2013
Specified country of birth Number % of women % of migrant women who gave birth (n=4,864)
1100 Australia 15,061 75.6
6104 India 790 4.0 16.2
2101 UK/Ireland 491 2.5 10.1
5101 China 432 2.2 8.9
4110 Vietnam 231 1.2 4.7
4107 Philippines 201 1.0 4.1
1301 New Zealand 178 0.9 3.7
3207 Sudan 134 0.7 2.8
6101 Afghanistan 125 0.6 2.6
4105 Malaysia 110 0.6 2.3
6107 Pakistan 102 0.5 2.1
6108 Sri Lanka 87 0.4 1.8
4109 Thailand 83 0.4 1.7
3103 Iran 81 0.4 1.7
9220 South Africa 76 0.4 1.6
4102 Cambodia 73 0.4 1.5
6102 Bangladesh 72 0.4 1.5
7104 USA 72 0.4 1.5
5105 South Korea 71 0.4 1.5
2504 Poland 60 0.3 1.2
4103 Indonesia 58 0.3 1.2
5103 Japan 57 0.3 1.2
6106 Nepal 56 0.3 1.2
9106 Congo 56 0.3 1.2
3104 Iraq 55 0.3 1.1
4106 Myanmar (Burma) 47 0.2 1.0
2305 Germany 46 0.2 0.9
9203 Burundi 45 0.2 0.9
7102 Canada 43 0.2 0.9
All other countries 931 4.7 19.1
Unknown 1 0.0 0.0
Total 19,925 100.0 100.0
* ASCCSS, Australian Bureau of Statistics
Pregnancy Outcome in South Australia 2013page 24
Mothers and Babies
6. Marital status and type of patient
While 89.9% women who gave birth in 2013 were married or in a de facto relationship, 10.1% were single (8.8%
were never married and 1.3% were widowed, separated or divorced, Table 6a). Of never married women, a fifth were
teenagers and a third were in their early twenties. Relatively more single women were hospital/public patients than
married women and women in de facto relationships (93.3% v 70.4%, Table 6b). Just over 27% of all women were
private patients.
Table 6a: Marital status and age, women who gave birth, South Australia, 2013
Age
(years)
Marital status of women
TotalNever married Married/de facto
Widowed/
separated /divorced Unknown
Number % Number % Number % Number % Number %
<20 349 19.9 315 1.8 0 0.0 2 14.3 666 3.3
20-24 579 33.0 2,248 12.6 49 19.5 5 35.7 2,881 14.5
25-29 404 23.0 5,385 30.1 66 26.3 3 21.4 5,858 29.4
30-34 246 14.0 6,272 35.0 57 22.7 1 7.1 6,576 33.0
35-39 135 7.7 2,966 16.6 54 21.5 3 21.4 3,158 15.8
40-44 39 2.2 694 3.9 24 9.6 0 0.0 757 3.8
45+ 1 0.1 27 0.2 1 0.4 0 0.0 29 0.1
Total 1,753 (8.8) 17,907 (89.9) 251 (1.3) 14 (0.1) 19,925 100.0
Table 6b: Type of patient and marital status, women who gave birth, South Australia, 2013
Type of
patient
Marital status of women
TotalNever married Married/ de facto
Widowed/
separated/ divorced Unknown
Number % Number % Number % Number % Number %
Hospital/
public
1,636 93.3 12,600 70.4 238 94.8 13 92.9 14,487 72.7
Private 117 6.7 5,307 29.6 13 5.2 1 7.1 5,438 27.3
Total 1,753 (8.8) 17,907 (89.9) 251 (1.3) 14 (0.1) 19,925 100.0
Pregnancy Outcome in South Australia 2013 page 25
Mothers and Babies
7. Occupation of father and mother
This categorisation is based on the Australian Statistical Classification of Occupations (ASCO) of the Australian Bureau
of Statistics and is provided in Table 7. Unclassified occupations have been assigned a separate category (Category 9).
A much larger proportion of mothers than fathers (24.3 versus 0.4%) were included in the occupation home duties .
Larger proportions were also found for the groups of clerks and salespeople and personal service workers. More
fathers were managers and administrators, tradespeople, plant and machine operators and labourers. Occupation was
unknown for 9.4% of fathers and 3.7% of mothers.
Table 7: Occupation* of father and mother, women who gave birth, South Australia, 2013
Occupation
Father Mother
Number % Number %
1 Managers and administrators 2,808 14.1 1,480 7.4
2 Professionals 3,158 15.8 3,384 17.0
3 Para professionals 1,079 5.4 1,406 7.1
4 Tradespersons 3,590 18.0 625 3.1
5 Clerks 513 2.6 2,110 10.6
6 Salespersons and personal service workers 1,064 5.3 2,764 13.9
7 Plant and machine operators and drivers 1,266 6.4 63 0.3
8 Labourers and related workers 2,515 12.6 526 2.6
9 Students 580 2.9 920 4.6
Pensioners 82 0.4 45 0.2
Home duties 78 0.4 4,832 24.3
Unemployed 987 5.0 809 4.1
Other 329 1.7 223 1.1
Unknown 1,876 9.4 738 3.7
Total 19,925 100.0 19,925 100.0
* Australian Bureau of Statistics. ASCO. First Edition. Occupation Definitions. Canberra: ABS,1990. (Catalogue No. 1223.0).
Pregnancy Outcome in South Australia 2013page 26
Mothers and Babies
8. Previous pregnancy outcomes
Forty-three percent of women had no previous birth and 31.4% were pregnant for the first time. Among Aboriginal
women and those of other races, these proportions were lower, with 35.8% and 37.6% respectively giving birth for
the first time. The proportion of women giving birth for the first time was the highest among Asian women (51.6%).
The proportion of women of parity 4 or greater was much higher among Aboriginal women (10%) and women of
other races (9.6%), than among Caucasian women (2.7%) and Asian women (1.3%) (Table 8a).
Table 8a: Parity by race, women who gave birth, South Australia, 2013
Parity
Race of women
TotalCaucasian Aboriginal Asian Other
Number % Number % Number % Number % Number %
0-primigravida 4,809 30.8 196 27.3 900 37.6 343 28.3 6,248 31.4
0-multigravida 1,876 12.0 61 8.5 335 14.0 114 9.4 2,386 12.0
1 5,449 34.9 172 24.0 881 36.8 361 29.7 6,863 34.4
2 2,341 15.0 142 19.8 192 8.0 179 14.7 2,854 14.3
3 706 4.5 74 10.3 56 2.3 100 8.2 936 4.7
4 244 1.6 33 4.6 21 0.9 61 5.0 359 1.8
?5 175 1.1 39 5.4 9 0.4 56 4.6 279 1.4
Total 15,600 78.3 717 3.6 2,394 12.0 1,214 6.1 19,925 100.0
Among women with previous pregnancies (multigravid women), the proportions who had had previous specified
adverse pregnancy outcomes are shown in Table 8b. Just over a third of the women had a previous miscarriage and a
fifth a termination of pregnancy.
Table 8b: Previous pregnancy outcomes, women who gave birth, South Australia, 2013
(multigravidae only, n= 13,677)
Previous pregnancy outcome Number %
Miscarriage 4,819 35.2
Termination of pregnancy 2,780 20.3
Stillbirth 189 1.4
Neonatal death 86 0.6
Ectopic pregnancy 331 2.4
Of the 11,291 women who had previously given birth, 3,467 (30.7%) had a previous caesarean section.
Pregnancy Outcome in South Australia 2013 page 27
Mothers and Babies
9a. Gestation at first antenatal visit
In 2013 gestation at the first antenatal visit was reported as unknown for 5.3% of women (Table 9a). If these
women with an unknown number of visits are excluded, among the remaining women, 80.8% attended within
the first 14 weeks. This proportion was much lower for Aboriginal women (53.4%) than for non-Aboriginal women
(81.7%).
Table 9a: Gestation at first antenatal visit, women who gave birth, by race, South Australia, 2013 (n=19,925)
Gestation
at first
antenatal
visit
Race of women
TotalNon-Aboriginal Aboriginal
Number %
Adjusted %
(excluding
unknown )
(n=18,213)
Number %
Adjusted %
(excluding
unknown )
(n=657)
Number %
Adjusted %
(excluding
unknown )
(n=18,870)
<14 weeks
gestation
14,889 77.5 81.7 351 49.0 53.4 15,240 76.5 80.8
14 weeks or
greater*
3,324 17.3 18.3 306 42.7 46.6 3,630 18.2 19.2
Unknown 995 5.2 60 8.4 1,055 5.3
Total 19,208 96.4 100.0 717 3.6 100.0 19,925 100.0 100.0
*includes 33 women with no antenatal care
9b. Body Mass Index (BMI)
Reported height and weight at the first antenatal visit were used to calculate the Body Mass Index (BMI, see Appendix
1) for women who gave birth. This was considered valid only for women who attended the first antenatal visit before
20 weeks gestation. Among these 17,911 women (89.9% of all women who gave birth), height and weight were not
reported for 1,689 women (9.4%), so that BMI could only be calculated for 16,222 women who gave birth in 2013
(81%). Table 9b shows that 8,423 women recorded a BMI >=25.0 (42.3% of all women giving birth), 3,900 (19.5%)
had a BMI >=30.0, and 1,641 (8.2%) had a BMI >=35.0.
Table 9b: BMI of women who gave birth, South Australia, 2013
BMI
(based on height and weight
at first antenatal visit where gestation
at first antenatal visit was <20 weeks)
Number %
Adjusted %
(excluding unknown )
(n=16,222)
<18.5 (underweight) 426 2.4 2.6
18.5 24.9 (normal) 7,373 41.2 45.5
25.0 29.9 (overweight) 4,523 25.3 27.9
30.0 34.9 (obese) 2,259 12.6 13.9
35.0 39.9 (severely obese) 1,004 5.6 6.2
40 or more (morbidly obese) 637 3.6 3.9
Unknown 1,689 9.4
Total 17,911 100.0
Pregnancy Outcome in South Australia 2013page 28
Mothers and Babies
9c. Antenatal visits
Women who gave birth are grouped in Table 9c according to the number of reported antenatal visits: no visits, 1 - 6
visits, 7 or more visits. However, for 4.7% of women (9.8% of Aboriginal women), the number of antenatal visits
attended was not reported. If women for whom the number of antenatal visits was not reported are excluded, 26.1%
of Aboriginal women compared with 7.3% of Caucasian women were reported to have made fewer than 7 visits.
Among Asian women this proportion was 10.2%. A low frequency of antenatal visits may be taken, particularly in
term births, as an indication of inadequate antenatal care. Although the exact number of antenatal visits was reported
for 18,982 (95.3%) women, 19,892 (99.8%) women report having attended at least one antenatal visit.
Table 9c: Antenatal visits by race, women who gave birth, South Australia, 2013
Antenatal
visits
Race of women
TotalCaucasian Aboriginal Asian Other
Number % Number % Number % Number % Number %
None 22 0.1 9 1.3 1 0.0 1 0.1 33 0.2
1-6 1,061 6.8 160 22.3 232 9.7 168 13.8 1,621 8.1
?7 13,806 88.5 478 66.7 2,055 85.8 989 81.5 17,328 87.0
Unknown
number of
visits
711 4.6 70 9.8 106 4.4 56 4.6 943 4.7
Total 15,600 (78.3) 717 (3.6) 2,394 (12.0) 1,214 (6.1) 19,925 (100.0)
9d. Type of antenatal care
In 2012 the types of antenatal care collected were updated to better reflect current obstetric practice. Table 9d
shows that the main types of antenatal care used were public hospital clinic (Specialist led) (41.5%), Obstetricians
+/-midwife in private practice (26.8%), General Practitioners and public hospital (shared care) (13.7%), Midwifery
group practice at birth hospital (11.1%) and General Practice led (8.6%). Individual women may have used more than
one type of antenatal care. There were 33 women (0.2%) who had no antenatal care.
Table 9d: Type of antenatal care, women who gave birth, South Australia, 2013 (n = 19,925)
Type of care Number %
No care 33 0.2
Midwifery group practice at birth hospital 2,212 11.1
Birth Unit/Centre 1,306 6.6
Public clinic (Specialist led) 8,263 41.5
GP and public hospital (shared care) 2,734 13.7
GP led 1,710 8.6
Obstetrician +/- midwife in private practice 5,341 26.8
Eligible midwife in private practice 68 0.3
Aboriginal Family Birthing Program (includes metropolitan and rural
locations)
181 0.9
Other 34 0.2
Not stated 16 0.1
Pregnancy Outcome in South Australia 2013 page 29
Mothers and Babies
10. Smoking
Table 10a shows that 11.1% of all women were reported to be smokers at their first antenatal visit, and 3.3% had
quit smoking before their first visit. Smoking status was unknown for 1.1% of women. The proportion of all women
smoking during pregnancy has been declining in the state, from 25% in 1998 to 11.1% in 2013.
The proportion of Aboriginal women who reported that they smoked at the first antenatal visit was (45%) down
slightly from 2012 (49.4%). However, this was considerably higher than non-Aboriginal women (9.8%). Additionally,
5.2% of Aboriginal women reported that they quit smoking in pregnancy prior to their first antenatal visit, compared
with 3.2% of non-Aboriginal women.
The highest rates of smoking were among teenagers (29%) and women aged 20-24 years (20.7%). Smoking rates
were high among all age groups of Aboriginal women varying from 34% among teenage women to 44.9% among
those aged 20-24 years.
In the second half of pregnancy (Table 10b), 9.6% of women (1,911 women) were reported to be smokers and 0.3%
(62 women) smoked more than 20 cigarettes per day, but the number of cigarettes smoked or whether the woman
smoked in the second half of pregnancy was not known for 1.7% of women. In the second half of pregnancy, 41.1%
of Aboriginal women smoked, compared with 8.3% of non-Aboriginal women. A higher proportion of Aboriginal
women (1.1% compared with 0.3%) also smoked more than 20 cigarettes per day, but the number of cigarettes
smoked was not known for 5.9% of Aboriginal women and 1.5% of non-Aboriginal women.
Table 10a: Tobacco smoking status at first antenatal visit, non-Aboriginal and Aboriginal women who gave
birth, South Australia, 2013
Smoking status
Non-Aboriginal Aboriginal Total
Number % Number % Number %
Smoker 1,883 9.8 323 45.0 2,206 11.1
Quit before 1st visit 614 3.2 37 5.2 651 3.3
Non-smoker 16,505 85.9 339 47.3 16,844 84.5
Unknown smoking status 206 1.1 18 2.5 224 1.1
Total 19,208 96.4 717 3.6 19,925 100.0
Table 10b: Average number of tobacco cigarettes smoked per day in the second half of pregnancy, non-
Aboriginal and Aboriginal women who gave birth, South Australia, 2013
Average number of tobacco
cigarettes smoked per day
Non-Aboriginal Aboriginal Total
Number % Number % Number %
None 17,295 90.0 380 53.0 17,675 88.7
Occasional (<1) 31 0.2 8 1.1 39 0.2
1-10 1,162 6.0 221 30.8 1,383 6.9
11-20 369 1.9 58 8.1 427 2.1
21-30 45 0.2 8 1.1 53 0.3
31-40 7 0.0 0 0.0 7 0.0
41+ 2 0.0 0 0.0 2 0.0
Unknown 297 1.5 42 5.9 339 1.7
Total 19,208 96.4 717 3.6 19,925 100.0
Pregnancy Outcome in South Australia 2013page 30
Mothers and Babies
11. Medical conditions
Medical conditions were recorded in the current pregnancy for 7,923 women (39.8%). The frequencies of specified
medical conditions are provided in Table 11. Up to four conditions can be reported for each pregnancy.
Table 11: Medical conditions in current pregnancy, women who gave birth, South Australia, 2013
Medical condition Number % of women (n = 19,925)
1 None 12,002 60.2
2 Anaemia 1,389 7.0
3 Urinary tract infection 442 2.2
4 Hypertension (pre-existing) 234 1.2
5 Diabetes (pre-existing) 165 0.8
6 Epilepsy 102 0.5
7 Asthma 1,360 6.8
8 Other 5,928 29.8
12. Obstetric complications
Obstetric complications were recorded for 7,855 women who gave birth (39.4%). The reported frequencies of the
more common complications are presented in Table 12. Up to four complications can be reported for each pregnancy.
There were three maternal deaths notified to the Maternal, Perinatal and Infant Mortality Committee in 2013, one
direct maternal death, one indirect maternal death and one incidental maternal death (see definition in Appendix 1).
Table 12: Frequency of some obstetric complications, women who gave birth, South Australia, 2013
Obstetric complication Number % of women (n= 19,925)
No complication 12,070 60.6
Threatened miscarriage 259 1.3
Antepartum haemorrhage (APH) - Abruption 80 0.4
APH - Placenta praevia 113 0.6
APH Other & unknown causes 454 2.3
Pregnancy hypertension 1,476 7.4
Intrauterine growth restriction (suspected) 930 4.7
Gestational diabetes 1,636 8.2
Other complications (including 7 women with impaired
glucose tolerance) 4,626 23.2
Pregnancy Outcome in South Australia 2013 page 31
Mothers and Babies
13. Procedures performed in current pregnancy
In 2012 procedures performed in the current pregnancy that are collected on the Supplementary Birth Record
were updated to better reflect current obstetric practice, and are presented in Table 13. At least one ultrasound
examination was performed for 97.6% of women, amniocentesis for 3.4% and chorion villus sampling for 0.8%.
For a proportion of women, it was not known whether a specific procedure had been performed, eg 1.4% for a first
trimester screen and 1.5% for a second trimester screen. It is hoped that the increasing use of the Pregnancy Record
will continue to reduce the number of unknown entries.
Table 13: Procedures performed in current pregnancy, women who gave birth, South Australia, 2013
Procedure
Yes No Unknown
Number % Number % Number %
First trimester anomaly screen
(Ultrasound & biochem) 13,498 67.7 6,144 30.8 283 1.4
Second trimester anomaly screen
(biochem only) 3,160 15.9 16,467 82.6 298 1.5
Ultrasound dating scan 11,263 56.5 7,436 37.3 1,226 6.2
Ultrasound morphology scan 17,331 87.0 2,400 12.0 194 1.0
Other ultrasound scan 7,700 38.6 11,938 59.9 287 1.4
Amniocentesis 679 3.4 19,093 95.8 153 0.8
Chorion villus biopsy 162 0.8 19,610 98.4 153 0.8
Antenatal fetal blood sampling 12 0.1 19,765 99.2 148 0.7
Other surgical procedure 98 0.5 19,827 99.5 0 0.0
14a. Onset of labour
Labour occurred spontaneously in 49.0% of women who gave birth (Table 14a). It was induced in 32.5%, and the
methods of induction used were artificial rupture of membranes (ARM) in 68.7% of inductions, prostaglandins in
54.1% and oxytocics in 57.5% (Table 14b). In many cases more than one method was used.
Table 14a: Onset of labour, women who gave birth, South Australia, 2013
Onset of labour Number %
Spontaneous 9,773 49.0
No labour caesarean section 3,676 18.4
Induction 6,476 32.5
Total 19,925 100.0
Table 14b: Method of induction of labour, women who gave birth, South Australia, 2013
Method of induction Number % of women (n =19,925) % of inductions (n =6,476)
No induction 13,449 67.5
ARM 4,450 22.3 68.7
Oxytocics 3,725 18.7 57.5
Prostaglandins 3,501 17.6 54.1
Pregnancy Outcome in South Australia 2013page 32
Mothers and Babies
14b. Reasons for induction of labour
Up to two reasons could be provided for induction. These reasons for induction of labour are defined (see page 55) in
The Australian Council on Healthcare Standards Obstetrics Indicators - Clinical Indicator Users Manual Version 5 for
use in 2007 .
Figure 4 demonstrates that 16.6% of women were induced for prolonged pregnancy (41 or more completed weeks),
15% for hypertension, 9.5% for diabetes (including gestational diabetes and glucose intolerance), 7.8% for
intrauterine growth restriction (IUGR) and 9.5% for premature rupture of membranes (PROM). Other defined reasons
accounted for smaller proportions. Other than defined reasons accounted for 45.7%.
Figure 4: Reasons for induction of labour, SA, 2013 (n=6,476)
The proportion of women giving birth who had labour augmented was 17.7%. Of the 9,773 women who went
into spontaneous labour, augmentation was used for 3,530 (36.1%). Methods used in augmentation were artificial
rupture of membranes (ARM) (72.3%), oxytocics (43.4%) and prostaglandins (0.9%). More than one method may be
used. It should be noted that prostaglandins are not recommended by the manufacturers as a method of augmenting
labour.
Table 14c: Augmentation of labour after spontaneous onset, women who gave birth, South Australia, 2013
Method of augmentation Number % of women (n=19,925) % of augmentations (n=3,530)
Any augmentation 3,530 17.7
1 ARM 2,552 12.8 72.3
2 Oxytocics 1,532 7.7 43.4
3 Prostaglandins 33 0.2 0.9
0 10 20 30 40 50 60
Other
Prolonged pregnancy
Chorioamnionitis
Fetal death
Fetal distress
Isoimmunisation
IUGR
Hypertensive disorders
PROM
Diabetes*
Percentage
*includes diabetes mellitus, gestational diabetes and glucose intolerance
Pregnancy Outcome in South Australia 2013 page 33
Mothers and Babies
15a. Presentation and method of birth
Of the women who gave birth, 53.9% had normal spontaneous vaginal births (Table 15a and Figure 5a). Caesarean
section was performed for 34% of women, with 16.2% of women having elective sections; forceps were utilised for
5.6%, ventouse for 5.9% and breech birth for the remaining 0.5%. The method of birth given for women who had
multiple births is that for the first birth. The method of birth by presentation for all births is provided in Table 15b.
Breech presentation occurred in 4.8% of births and caesarean section was the method of birth for 87.7% of breech
presentations. Caesarean section was also utilised for 87.7% of breech presentations in singletons (Table 15c).
Table 15a: Method of birth, women who gave birth, South Australia, 2013
Method of birth Number %
Normal spontaneous vaginal 10,746 53.9
Forceps 1,124 5.6
Assisted breech (no forceps) 22 0.1
Caesarean section (elective) 3,237 16.2
Caesarean section (emergency) 3,541 17.8
Ventouse 1,175 5.9
Breech extraction 5 0.0
Breech spontaneous 71 0.4
Assisted breech (with forceps for head) 3 0.0
Unknown 1 0.0
Total 19,925 100.0
Figure 5a: Method of birth, women who gave birth, South Australia, 2013 (n = 19,925)
Ventouse (5.9%)
Caesarean section (34%)
Normal
spontaneous
vaginal (53.9%)
Breech delivery (0.5%)
Forceps (5.6%)
Pregnancy Outcome in South Australia 2013page 34
Mothers and Babies
Table 15b: Method of birth by presentation, all births, South Australian 2013 (n=20,263)
Method of
birth
Presentation
TotalVertex Breech Other Unknown
Number % Number % Number % Number % Number %
Normal
spontaneous 10,732 56.4 0 0.0 55 23.7 7 26.9 10,794 53.3
Forceps 1,127 5.9 0 0.0 9 3.9 0 0.0 1,136 5.6
Assisted breech
(no forceps) 0 0.0 27 2.8 0 0.0 0 0.0 27 0.1
Elective
caesarean 2,798 14.7 516 52.7 40 17.2 5 19.2 3,359 16.6
Emergency
caesarean 3,194 16.8 343 35.0 122 52.6 12 46.2 3,671 18.1
Ventouse 1,175 6.2 0 0.0 5 2.2 0 0.0 1,180 5.8
Breech
extraction 0 0.0 12 1.2 0 0.0 0 0.0 12 0.1
Breech
spontaneous 0 0.0 76 7.8 1 0.4 1 3.8 78 0.4
Assisted breech
(forceps) 0 0.0 5 0.5 0 0.0 0 0.0 5 0.0
Unknown 0 0.0 0 0.0 0 0.0 1 3.8 1 0.0
Total 19,026 (93.9) 979 (4.8) 232 (1.1) 26 (0.1) 20,263 100.0
Table 15c: Method of birth in breech presentation, by plurality, all births, South Australia, 2013 (n = 979)
Plurality Assisted* breech
Elective
caesarean
Emergency
caesarean
Breech
extraction
Breech
spontaneous Total
Singleton 25 424 269 5 67 790
Twins 7 88 70 7 8 180
Triplets 0 4 4 0 1 9
Total 32 516 343 12 76 979
* in five of the assisted breech births forceps were applied to the head.
Pregnancy Outcome in South Australia 2013 page 35
Mothers and Babies
15b. Reason for caesarean section
Up to two reasons may be provided on the Supplementary Birth Record for caesarean section, and these have been
collated in Figure 5b (all caesarean sections), Figure 5c (elective caesarean sections only) and Figure 5d (emergency
caesarean sections only). The main reasons given for all caesarean sections were previous caesarean section (36.1%),
failure to progress/cephalopelvic disproportion (CPD) (27.1%), fetal distress (14.8%) and malpresentation (11%).
Maternal choice accounted for 2.6% (up from 1.5%in 2012 when it was first added). The main reasons for elective
sections were previous caesarean section (65.3%), malpresentation (13.1%), maternal choice (4.4%) and multiple
pregnancy (3.2%). The main reasons given for emergency sections were failure to progress or CPD (50.5%), fetal
distress (28.2%), previous caesarean section (9.4%), malpresentation (9.1%) and maternal choice (0.9%).
Figure 5b: Reason for caesarean section, 2013 (n=6,778)
Figure 5c: Reason for elective caesarean section, 2013 (n=3,237)
0.0 10.0 20.0 30.0 40.0 50.0 60.0 70.0
Other
Maternal choice
Intrauterine Growth
Restriction (IUGR)
Multiple pregnancy
Antepartum
Haemorrhage (APH)
Pregnancy hypertension/
hypertension
Malpresentation
Fetal distress
Previous caesarean
CPD/Failure to progress
Percentage
0.0 10.0 20.0 30.0 40.0 50.0 60.0 70.0
Other
Maternal choice
IUGR
Multiple pregnancy
APH
Pregnancy hypertension/
hypertension
Malpresentation
Fetal distress
Previous caesarean
CPD
Percentage
Pregnancy Outcome in South Australia 2013page 36
Mothers and Babies
Figure 5d: Reason for emergency caesarean section, 2013 (n=3,541)
16. Complications of labour and birth and perineal status after birth
Complications of labour or birth were recorded for 7,552 women who gave birth (37.9%). Up to four complications
can be recorded. The reported frequency of some complications is presented in Table 16. Among all 19,925 women
who gave birth, episiotomy was performed for 2,653 (13.3%). Among the 13,147 women who gave birth vaginally,
3,400 (25.9%) had an intact perineum after birth, 5,282 (40.2%) had a repair of a perineal tear, of whom 431 (3.3%)
had a third or a fourth degree tear; 20.2% had an episiotomy.
Table 16: Frequency of some complications of labour and birth, women who gave birth, South Australia, 2013
Complication of labour Number of women % of women (n=19,925)
None 12,373 62.1
Postpartum Haemorrhage (PPH) - 600-999ml 1,559 7.8
PPH 1,000 ml or more 909 4.6
PPH primary (amount not specified) 7 0.0
Fetal distress 2,316 11.6
Retained placenta 255 1.3
Prolonged labour 140 0.7
Cord prolapse 35 0.2
Wound infection 16 0.1
Third degree tear (391) or fourth degree tear (31) 431 2.2
Failure to progress 2,558 12.8
Other 4,794 24.1
0.0 10.0 20.0 30.0 40.0 50.0 60.0
Other
Maternal choice
IUGR
Multiple pregnancy
APH
Pregnancy hypertension/hypertension
Malpresentation
Fetal distress
Previous caesarean
CPD/Failure to progress
Percentage
Pregnancy Outcome in South Australia 2013 page 37
Mothers and Babies
17. Fetal monitoring during labour
Cardiotocography (CTG) was performed during labour for 63.3% of women who gave birth. The majority of these
(49.9% of women) were external CTGs (Table 17a) while a scalp clip was used for 13.4%.
A fetal scalp pH was taken during labour in 214 women who gave birth (1.1%, Table 17b).
Table 17a: CTG performed during labour, women who gave birth, South Australia, 2013
CTG during labour Number of women % of women (n=19,925)
1 None 7,310 36.7
2 External 9,936 49.9
3 Scalp clip 2,679 13.4
Table 17b: Fetal scalp pH taken during labour, women who gave birth, South Australia, 2013
Fetal scalp pH taken Number of women % of women (n=19,925)
1 No 19,711 98.9
2 Yes 214 1.1
18. Analgesia for labour and anaesthesia for birth
These distributions are provided in Tables 18a and 18b. Epidurals were used for analgesia in labour for 31.3% and
for anaesthesia for birth for 27.3% of women. The proportion of women who had an epidural for either was 32.6%
(6,501 women). The proportion of women who had a spinal anaesthetic increased between 1991 and 2013 from
0.2% to 1.0% for analgesia and from 0.5% to 25.2% for anaesthesia. General anaesthesia was used for 2.1% of
births. It was used in 5.9% of caesarean sections. Approximately 37% of women who gave birth received none of the
specified methods for analgesia during labour.
Table 18a: Analgesia for labour,* women who gave birth, South Australia, 2013
Analgesia Number % of women
1 None 7,339 36.8
2 Nitrous oxide and oxygen 8,245 41.4
3 Narcotic (parenteral) 3,157 15.8
4 Epidural (lumbar/caudal) 6,237 31.3
5 Spinal 192 1.0
6 Other 489 2.5
7 Combined spinal-epidural 14 0.1
* more than one method may be used for each woman
Pregnancy Outcome in South Australia 2013page 38
Mothers and Babies
Table 18b: Anaesthesia for birth,* women who gave birth, South Australia, 2013
Anaesthesia Number % of women
1 None 7,476 37.5
2 Local anaesthesia 1,762 8.8
3 Pudendal 159 0.8
4 Epidural (lumbar/caudal) 5,431 27.3
5 Spinal 5,015 25.2
6 General anaesthesia 409 2.1
7 Other 178 0.9
8 Combined spinal-epidural 68 0.3
* more than one method may be used for each woman
19. Postnatal length of stay of women
The distribution of length of stay of women who gave birth in hospitals is presented in Table 19a for public and
private patients. The median duration for all women was three days. It was two days for vaginal births and four days
for caesarean section births (Table 19b).
The median duration of stay was two days longer for private patients for vaginal as well as caesarean births (four and
five days respectively for private patients compared with two and three days respectively for public patients).
Table 19a: Postnatal length of stay by type of patient, women who gave birth in South Australian hospitals, 2013
Postnatal length of
stay (days)
Public Private Total
Number % Number % Number %
<1 924 6.4 26 0.5 950 4.8
1 2,927 20.3 84 1.6 3,011 15.2
2 3,764 26.1 215 4.0 3,979 20.1
3 3,586 24.9 670 12.4 4,256 21.5
4 1,931 13.4 2,151 39.9 4,082 20.6
5 814 5.6 1,610 29.8 2,424 12.2
6 238 1.7 470 8.7 708 3.6
7 or more 233 1.6 168 3.1 401 2.0
Total 14,417 100.0 5,394 100.0 19,811 100.0
Table 19b: Average postnatal length of stay by type of patient & type of birth, women who gave birth in
South Australian hospitals, 2013
Average
length of stay
Public Private Total
Vaginal
(n=9,849)
Caesarean
(n=4,568)
Total
(n=14,417)
Vaginal
(n=3,184)
Caesarean
(n=2,210)
Total
(n=5,394)
Vaginal
(n=13,033)
Caesarean
(n=6,778)
Total
(n=19,811)
Mean number
of days
2.0 3.7 2.5 3.8 5.0 4.3 2.4 4.1 3.0
( SD) ( 1.42) ( 1.58) ( 1.67) ( 1.42 ( 1.08) ( 1.43) ( 1.62) ( 1.57) ( 1.80)
Median
number of days 2.0 3.0 2.0 4.0 5.0 4.0 2.0 4.0 3.0
Pregnancy Outcome in South Australia 2013 page 39
Mothers and Babies
20. Sex of baby
The sex distribution of babies is provided in Table 20; the male: female sex ratio was 1.08:1.
Table 20: Sex of baby, all births, South Australia, 2013
Sex of baby Number %
Male 10,531 52.0
Female 9,731 48.0
Indeterminate 1 0.0
Total 20,263 100.0
21. Birthweight and gestation
The birthweight distribution of all births is presented in Table 21. The percentage of low birthweight babies (<2,500g)
was 7.7%, and that of very low birthweight babies (<1,500g) was 1.7%. The mean birthweight was 3,312g (SD
624.8g), with birthweights ranging from 91g to 5850g. The proportion of low birthweight babies was 15.4% among
babies of Aboriginal women compared with 7.4% among babies of non-Aboriginal women. Among live born babies,
and excluding terminations of pregnancy, these proportions were 14.8% and 6.9% respectively.
Table 21: Birthweight distribution of all births, South Australia, 2013
Birthweight (g) Number of births Percentage of births
<400 50 0.2
400-499 21 0.1
500-749 62 0.3
750-999 67 0.3
1,000-1,499 137 0.7
1,500-1,999 339 1.7
2,000-2,499 876 4.3
2,500-2,999 3,314 16.4
3,000-3,499 7,386 36.5
3,500-3,999 5,922 29.2
4,000-4,499 1,801 8.9
4,500+ 287 1.4
Unknown 1 0.0
Total 20,263 100.0
In 2013, 1,552 babies (7.7%) were of low birthweight and 1,983 (9.8%) were preterm (<37 weeks gestation). The
proportion of preterm births was 18% among babies of Aboriginal women compared with 9.5% among babies of
non-Aboriginal women.
Pregnancy Outcome in South Australia 2013page 40
Mothers and Babies
22. Birth injuries
Birth injuries were reported in 168 live births (0.8%). The most common injury reported was cephalhaematoma.
Fracture and nerve injury occurred less frequently (Table 22).
Table 22: Birth injuries* in 20,125 live births, South Australia, 2013
Birth injury Number of live births % of live births
None 19,957 99.2
Fracture 11 0.1
Dislocation 2 0.0
Nerve Injury 16 0.1
Cephalhaematoma 128 0.6
Other 14 0.1
*more than one injury may be reported for each birth
23. Treatment given in neonatal period
The proportions of live births who received specified treatments in the neonatal period are provided in Table 23, which
shows that 83.9% of neonates did not receive any of these treatments.
Table 23: Neonatal treatment given, all live births, South Australia, 2013
Neonatal treatment Number % of live births
None of the treatments listed below 16,893 83.9
Oxygen therapy for more than 4 hours 860 4.3
Phototherapy for jaundice 1,391 6.9
Gavage feeding more than once 1,633 8.1
Any intravenous therapy 2,212 11.0
24. Level of care* utilised
Table 24 shows that 83.4% of neonates utilised Level 1-3 care only. Level 4 - 5 care was used by 16.5% of neonates,
Level 6 care at the Women s and Children s Hospital or Flinders Medical Centre by 2.7% and paediatric intensive care
at the Women s and Children s Hospital by 0.2% of neonates. As would be expected, with decreasing birthweight, an
increasing percentage of babies required Level 4-5 and Level 6 care.
Table 24: Level of nursery care* utilised by birthweight, all live births, South Australia, 2013
Level of care utilised
Birthweight (g)
<1,500 (n=238) 1,500-2,499 (n=1,204) 2,500+ (n=18,683) Total (n=20,125)
Number % Number % Number % Number %
Level I - 3 only 21 8.8 228 18.9 16,529 88.5 16,778 83.4
Level 4 - 5 208 87.4 972 80.7 2,137 11.4 3,317 16.5
Level 6 (W&CH & FMC) 192 80.7 191 15.9 159 0.9 542 2.7
Level 6 (W&CH Paediatric
intensive care) 5 2.1 5 0.4 40 0.2 50 0.2
*Standards for Maternal and Neonatal Services in South Australia 2010
Pregnancy Outcome in South Australia 2013 page 41
Mothers and Babies
25. Length of stay of babies
Table 25 shows the distribution of length of stay of liveborn babies in hospital for preterm (<37 weeks gestation) and
term births (?37 weeks gestation). The mean duration of stay for all liveborn babies was 4.8 days (SD 9.4) and the
median duration 3 days. The mean duration was 3.2days (SD 3.2) for term births and 20.7 days (SD 23.8) for preterm
births, while the median durations were 3 and 13 days respectively.
Table 25: Length of stay of liveborn babies in hospital, South Australia, 2013
Length of stay (days)
Preterm births Term births Total
Number % Number % Number %
<1 27 1.4 870 4.8 897 4.5
1 24 1.3 2,813 15.5 2,837 14.2
2 75 4.0 3,594 19.8 3,669 18.3
3 100 5.4 3,806 21.0 3,906 19.5
4 126 6.7 3,740 20.6 3,866 19.3
5 138 7.4 2,189 12.1 2,327 11.6
6 102 5.5 625 3.4 727 3.6
7-13 377 20.2 383 2.1 760 3.8
14-20 265 14.2 58 0.3 323 1.6
21-27 184 9.9 27 0.1 211 1.1
28 or more 449 24.0 39 0.2 488 2.4
Total 1,867 100.0 18,144 100.0 20,011 100.0
26. Congenital anomalies
Among the 20,263 births in 2013 there were 565 births (2.8%) notified with congenital anomalies, compared with an
average of 2.5% over the past decade; 530 (2.6%) of these births had anomalies notified in the congenital anomalies
range 74000-75999 of the British Paediatric Association (BPA) Classification of Diseases. This is a 5-digit extension of
the 4-digit classification of the ICD-9 (International Classification of Diseases. Manual of the International Statistical
Classification of Diseases, Injuries and Causes of Death, 1975 Revision. Geneva: World Health Organisation, 1977).
Table 26 includes births with the more readily identifiable defects used for international monitoring (sentinel defects)
notified to the perinatal statistics collection in 2003-2013.
Terminations of pregnancy are not included in this table unless they meet a criterion for inclusion in the perinatal data
collection, i.e. at least 400g birthweight or 20 weeks gestation. Notifications of births with birth defects identified
after discharge from the hospital of birth but within the first five years of life are made to the South Australian Birth
Defects Register at the Women s and Children s Hospital, and more complete statistics on birth defects in South
Australia are available from the Register s Annual Report.2
Pregnancy Outcome in South Australia 2013page 42
Mothers and Babies
Table 26: Selected congenital anomalies notified to the perinatal statistics collection, 2003-2013, South Australia
Congenital
abnormality Year
BPA* CODE 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013
Number of births = 17,844 17,522 18,196 18,803 19,757 19,970 19,901 20,002 20,344 20,666 20,263
74000-74029 Anencephalus 0 1 0 1 1 1 3 1 2 2 2
74100-74199 Spina bifida 7 5 5 8 5 4 18 11 6 4 7
74200-74209 Encephalocele 0 0 1 1 2 1 0 1 0 1 2
74230-74239 Hydrocephalus 7 6 9 10 12 11 14 4 9 11 13
74900-74909 Cleft palate 9 10 15 11 12 9 11 12 11 14 12
74910-74929 Cleft lip and
palate (Total cleft lip)
14 17 9 16 30 28 25 18 13 14 14
75030-75038 Tracheo-
oesophageal fistula,
oesophageal atresia and
stenosis
2 2 5 4 12 5 6 3 6 5 7
75120-75124 Atresia and
stenosis of large intestine,
rectum and anal canal
6 6 12 4 7 9 7 9 10 5 8
75260-75261 Hypospadias
and epispadias
34 41 38 29 41 40 39 44 43 38 44
75300-75301 Renal agenesis
and dysgenesis
10 4 12 8 8 3 11 8 12 10 7
75520-75549 Limb reduction
defects
5 8 8 13 18 9 8 13 8 15 17
75660-75669 Anomalies of
diaphragm
4 4 7 12 7 9 9 6 5 1 8
75670-75679 Anomalies of
abdominal wall
13 12 9 10 7 9 17 7 15 14 8
75800-75809 Down
syndrome
13 14 19 17 17 21 22 14 16 19 14
* British Paediatric Association Classification of Diseases. London: The British Paediatric Association, 1979.
27. Multiple births
Among women who gave birth there were 320 twin and 9 triplet pregnancies compared with 19,596 singleton
ones in 2013. Thus there was one twin pregnancy in every 62 pregnancies, one triplet pregnancy in every 2,214
pregnancies among women who gave birth. Women who gave birth with twins and triplets comprised 1.6% of all
women who gave birth. The total number of multiple births was 667 (3.3% of total births).
A comparison of multiple births with singletons shows that multiple births were of lower birthweight (with 63%
being of low birthweight compared with 5.8% for singletons, Table 27a), and gestation (with 70.6% being preterm
births compared with 7.7% for singletons, Table 27b). The proportion of live births in hospital at 28 days was 26.1%
for multiple births compared with 1.6% for singletons. The perinatal death rate for multiple births was 16.5 compared
with 8.8 deaths per 1,000 births for singletons, Table 27c).
Pregnancy Outcome in South Australia 2013 page 43
Mothers and Babies
Table 27a: Birthweight by plurality, all births, South Australia, 2013
Birthweight (g)
Singleton births Multiple births
Number % Number %
<400 46 0.2 4 0.6
400-499 21 0.1 0 0.0
500-749 52 0.3 10 1.5
750-999 45 0.2 22 3.3
1,000-1,499 98 0.5 39 5.8
1,500-1,999 202 1.0 137 20.5
2,000-2,499 668 3.4 208 31.2
2,500-2,999 3,114 15.9 200 30.0
3,000-3,499 7,344 37.5 42 6.3
3,500-3,999 5,917 30.2 5 0.7
4,000-4,499 1,801 9.2 0 0.0
4,500+ 287 1.5 0 0.0
Unknown 1 0.0 0 0.0
Total 19,596 100.0 667 100.0
Table 27b: Gestation at birth by plurality all births, South Australia, 2013
Gestation (weeks)
Singleton births Multiple births Total
Number % Number % Number %
<24 94 0.5 7 1.0 101 0.5
24-27 68 0.3 28 4.2 96 0.5
28-31 131 0.7 54 8.1 185 0.9
32-36 1,219 6.2 382 57.3 1,601 7.9
37-41 18,027 92.0 196 29.4 18,223 89.9
42+ 56 0.3 0 0.0 56 0.3
Unknown 1 0.0 0 0.0 1 0.0
Total 19,596 100.0 667 100.0 20,263 100.0
Table 27c: Perinatal outcome by plurality, all births, South Australia, 2013
Perinatal outcome
Singleton births Multiple births Total
Number % Number % Number %
Stillbirth 134 0.7 4 0.6 138 0.7
Discharged within 28 days 19,108 97.5 483 72.4 19,591 96.7
In hospital at 28 days 316 1.6 173 25.9 489 2.4
Neonatal death 38 0.2 7 1.0 45 0.2
Total 19,596 100.0 667 100.0 20,263 100.0
Pregnancy Outcome in South Australia 2013page 44
Mothers and Babies
28. Perinatal mortality
High crude perinatal mortality rates were associated with low birthweight births (Table 28a), low gestation births
(Table 28b) and multiple births (Table 27c).7 The perinatal mortality rate for all births (livebirths of any gestation and
stillbirths of at least 400g birthweight/20 weeks gestation) in 2013 was 9 per 1,000 births. The stillbirth rate was 6.8
per 1,000 births and the neonatal mortality rate was 2.2 per 1,000 live births.
The relationship between perinatal mortality and birthweight is demonstrated in Table 28a and Figure 6. The highest
perinatal mortality rate was observed for the lowest birthweight group weighing <500g (985.9 per 1,000). The
lowest perinatal mortality rate of 0.6 per 1,000 births was observed for births weighing 4,000 4,499g. The perinatal
mortality rate for the birthweight group 3,500-3,999g was 0.7 per 1,000 births, and the 4,500+g birthweight group
was 3.5 per 1000 births. The perinatal mortality rate for babies of normal birthweight (2,500g or more) was 2.1 per
1,000 births. The decline in perinatal mortality with increasing gestational age is demonstrated in Table 28b.
More detail regarding perinatal mortality is available in the Maternal, Perinatal and Infant Mortality in South Australia reports.3
Table 28a: Perinatal mortality by birthweight, all births, South Australia, 2013
Birthweight
(g)
Total
births
Live
births
Stillbirths Neonatal deaths Perinatal deaths
Number
Deaths per
1,000 births Number
Deaths per
1,000 live
births Number
Deaths per
1,000 births
<400 50 5 45 900.0 5 1,000.0 50 1,000.0
400-499 21 9 12 571.4 8 888.9 20 952.4
500-749 62 34 28 451.6 10 294.1 38 612.9
750-999 67 61 6 89.6 3 49.2 9 134.3
1,000-1,499 137 129 8 58.4 0 0.0 8 58.4
1,500-1,999 339 334 5 14.7 4 12.0 9 26.5
2,000-2,499 876 870 6 6.8 3 3.4 9 10.3
2,500-2,999 3,314 3,305 9 2.7 4 1.2 13 3.9
3,000-3,499 7,386 7,372 14 1.9 6 0.8 20 2.7
3,500-3,999 5,922 5,920 2 0.3 2 0.3 4 0.7
4,000-4,499 1,801 1,800 1 0.6 0 0.0 1 0.6
4,500+ 287 286 1 3.5 0 0.0 1 3.5
Unknown 1 0 1 1,000.0 0 0.0 1 1,000.0
Total 20,263 20,125 138 6.8 45 2.2 183 9.0
Figure 6: Perinatal mortality rate by birthweight, all births, South Australia, 2013
0.1
1.0
10.0
100.0
1000.0
<5
00
50
0-
75
0-
10
00
-
15
00
-
20
00
-
25
00
-
30
00
-
35
00
-
40
00
-
45
00
+
Birthweight (g)
Pe
ri
n
at
al
d
ea
th
s
p
er
1
,0
00
b
ir
th
s
(l
o
g
ar
it
h
m
ic
s
ca
le
)
Pregnancy Outcome in South Australia 2013 page 45
Mothers and Babies
Table 28b: Perinatal mortality by gestational age at birth, South Australia, 2013
Gestational
age at birth
(weeks)
Total
births
Live
births
Stillbirths Neonatal deaths Perinatal deaths
Number
Deaths
per 1,000
births Number
Deaths per
1,000 live
births Number
Deaths per
1,000 births
<24 101 23 78 772.3 21 913.0 99 980.2
24-27 96 85 11 114.6 5 58.8 16 166.7
28-31 185 177 8 43.2 2 11.3 10 54.1
32-36 1,601 1,585 16 10.0 6 3.8 22 13.7
37-41 18,223 18,199 24 1.3 10 0.5 34 1.9
42+ 56 55 1 17.9 0 0.0 1 17.9
Unknown 1 1 0 0.0 1 1000.0 1 1000.0
TOTAL 20,263 20,125 138 6.8 45 2.2 183 9.0
The perinatal mortality rates for other specified minimum birthweights or gestational ages (where birthweight was
unavailable) are provided in Table 28c. The perinatal mortality rate recommended by the World Health Organisation
(WHO) for use in international comparison refers only to stillbirths of at least 1,000g birthweight (or, if birthweight
is unavailable, 28 weeks gestation) and to (early) neonatal deaths within the first 7 days of life. This rate was 3.2 per
1,000 births in 2013, with a stillbirth rate of 2.3 per 1,000 births and an early neonatal mortality rate of 0.5 per 1,000
live births. The perinatal mortality rate for births to Aboriginal women was 15.1 per 1,000 births in 2013 compared
with 8.8 per 1,000 births for births to non-Aboriginal women (Table 28d).
Table 28c: Perinatal mortality, South Australia, 2013 (all births of specified birthweight/gestation)
Specified
birthweight/
gestation
Total
births
Live
births
Stillbirths Neonatal deaths Perinatal deaths
Number Number Number
Deaths
per 1,000
births Number
Deaths
per 1,000
live births Number
Deaths
per 1,000
births
?400g/20 weeks* 20,263 20,120 138 6.8 45 2.2 183 9.0
?500g/22 weeks 20,191 20,111 80 4.0 32 1.6 112 5.5
(WHO National Statistics) 23 1.1 103 5.1
?1,000g/28 weeks 20,062 20,016 46 2.3 19 0.9 65 3.2
(WHO International
Statistics)
11** 0.5 57 2.8
* There were 50 births of birthweight <400g
** only neonatal deaths within the first 7 days of life are included
Pregnancy Outcome in South Australia 2013page 46
Mothers and Babies
Table 28d: Perinatal mortality by race, all births, South Australia, 2013
Race
Total births Stillbirths Neonatal deaths Alive at 28 days Perinatal deaths
Number Number Number Number Number
Deaths per
1,000 births
Caucasian 15,877 103 32 15,742 135 8.5
Aboriginal 729 7 4 718 11 15.1
Asian 2,422 15 6 2,401 21 8.7
Other 1,235 13 3 1,219 16 13.0
Total 20,263 138 45 20,080 183 9.0
29. Home births
Supplementary Birth Records were received from home birth midwives regarding planned home births for 107 women
which occurred at home in 2013. There were seven unplanned home births in South Australia in 2013 which have
been excluded from the planned home birth statistics. All but one of these women received some antenatal care.
Ascertainment of planned home births occurring at home in South Australia for the year 2013 is estimated to be
84.3% (107 out of an estimated 127 home births). This estimate has been derived from a comparison with data from
the Births, Deaths and Marriages Registration Division on births registered, which did not occur in hospital (and were
not BBAs - babies born before arrival at the hospital into which the woman had been booked). This proportion was a
marked increase on last year (66.2%) and has returned to pre 2011 ascertainment levels. In addition, 37 women who
planned to birth at home were transferred to hospital care before birth. Statistics for all 144 planned home births in
2013 are provided in Tables 29-32, by place of birth.
Table 29: Planned home births by age of women, South Australia, 2013
Age (years)
Birthed at home Birthed in hospital Total
Number % Number % Number %
<20 1 0.9 0 0.0 1 0.7
20-24 5 4.7 2 5.4 7 4.9
25-29 31 29.0 12 32.4 43 29.9
30-34 35 32.7 12 32.4 47 32.6
35-39 30 28.0 11 29.7 41 28.5
40-44 5 4.7 0 0.0 5 3.5
Total 107 100.0 37 100.0 144 100.0
Pregnancy Outcome in South Australia 2013 page 47
Mothers and Babies
Table 30: Method of birth in planned home births, South Australia, 2013
Method of birth
Birthed at home Birthed in hospital Total
Number % Number % Number %
Normal spontaneous vaginal 105 98.1 20 54.1 125 86.8
Forceps 0 0.0 4 10.8 4 2.8
Elective caesarean section 0 0.0 1 2.7 1 0.7
Emergency caesarean section 0 0.0 11 29.7 11 7.6
Ventouse 0 0.0 1 2.7 1 0.7
Breech spontaneous 2 1.9 0 0.0 2 1.4
Total 107 100.0 37 100.0 144 100.0
Table 31: Birthweight distribution of planned home births, South Australia, 2013
Birthweight (g)
Birthed at home Birthed in hospital Total
Number % Number % Number %
1,500-1,999 1 0.9 0 0.0 1 0.7
2,000-2,499 1 0.9 1 2.7 2 1.4
2,500-2,999 9 8.4 6 16.2 15 10.4
3,000-3,499 26 24.3 11 29.7 37 25.7
3,500-3,999 46 43.0 14 37.8 60 41.7
4,000-4,499 22 20.6 4 10.8 26 18.1
4,500+ 2 1.9 1 2.7 3 2.1
Total 107 100.0 37 100.0 144 100.0
Table 32: Perinatal outcome in planned home births, South Australia, 2013
Perinatal outcome
Birthed at home Birthed in hospital Total
Number % Number % Number %
Stillbirth - - - - - -
Discharged within 28 days 107 100.0 37 100.0 144 100.0
Neonatal death - - - - - -
Total 107 100.0 37 100.0 144 100.0
Pregnancy Outcome in South Australia 2013page 48
Mothers and Babies
30. Birthing unit births
Statistics presented for births in birthing units in South Australia (Tables 33-36) relate to the birthing units at the
Women s and Children s Hospital, the Lyell McEwin Hospital and Flinders Medical Centre. The units at the Women s
and Children s Hospital and the Lyell McEwin Hospital were established in 1992 and 1993 respectively under the
Alternative Birthing Services Programme. In October 1996 the birthing unit at Flinders Medical Centre commenced
a birthing service.5 These statistics relate to all 2,327 women for whom it was reported that birthing unit was
their intended place of birth. Of these women, 1,291gave birth in the birthing units while 1,036 women (44.5%)
gave birth in labour wards. Some of these women were transferred to labour wards because of medical or obstetric
complications. With the commencement of the Midwifery Group Practice model of care at Women s and Children s
Hospital in 2004, more of these women who gave birth in labour wards than previously did so because the birthing
unit was not available at the time. Among the women who gave birth in labour wards, 34.5% had caesarean
sections and 16.3% had instrumental births. These statistics have also been included in the statistics for the respective
hospitals. Sixty-three babies (2.7%) were of low birthweight and there were 11 perinatal deaths (perinatal mortality
rate 4.7 per 1,000 births).
Table 33: Planned birthing unit births by age of women, South Australia, 2013
Age
(years)
Birthed in birthing unit Birthed in labour ward Total
Number % Number % Number %
<20 55 4.3 53 5.1 108 4.6
20-24 245 19.0 173 16.7 418 18.0
25-29 449 34.8 345 33.3 794 34.1
30-34 384 29.7 297 28.7 681 29.3
35-39 140 10.8 146 14.1 286 12.3
40-44 17 1.3 22 2.1 39 1.7
45+ 1 0.1 0 0.0 1 0.0
Total 1,291 100.0 1,036 100.0 2,327 100.0
Table 34 Method of birth in planned birthing unit births, South Australia, 2013
Method of birth
Birthed in birthing unit Birthed in labour ward Total
Number % Number % Number %
Normal spontaneous vaginal 1,245 96.4 506 48.9 1,751 75.2
Forceps 12 0.9 103 9.9 115 4.9
Assisted breech (no forceps) 0 0.0 1 0.1 1 0.0
Caesarean section (elective) 0 0.0 45 4.3 45 1.9
Caesarean section
( emergency)
0 0.0 312 30.1 312 13.4
Ventouse 33 2.6 66 6.4 99 4.3
Breech spontaneous 1 0.1 3 0.3 4 0.2
Assisted breech (forceps) 0 0.0 0 0.0 0 0.0
Total 1,291 100.0 1,036 100.0 2,327 100.0
Pregnancy Outcome in South Australia 2013 page 49
Mothers and Babies
Table 35: Birthweight distribution of planned birthing unit births, South Australia, 2013
Birthweight (g)
Birthed in birthing unit Birthed in labour ward Total
Number % Number % Number %
<1,500 0 0.0 15 1.4 15 0.6
1,500-1,999 0 0.0 9 0.9 9 0.4
2,000-2,499 4 0.3 35 3.4 39 1.7
2,500-2,999 156 12.1 132 12.7 288 12.4
3,000-3,499 473 36.6 374 36.0 847 36.4
3,500-3,999 477 36.9 325 31.3 802 34.4
4,000-4,499 160 12.4 122 11.7 282 12.1
4,500+ 21 1.6 26 2.5 47 2.0
Total 1,291 100.0 1,038 100.0 2,329 100.0
Table 36: Perinatal outcome in planned birthing unit births, South Australia, 2013
Perinatal outcome
Birthed in birthing unit Birthed in labour ward Total
Number % Number % Number %
Stillbirth 1 0.1 9 0.9 10 0.4
Discharged within 28 days 1,289 99.8 1,013 97.6 2,302 98.8
Prolonged hospitalisation (in
hospital at 28 days)
1 0.1 15 1.4 16 0.7
Neonatal death 0 0.0 1 0.1 1 0.0
Total 1,291 100.0 1,038 100.0 2,329 100.0
Pregnancy Outcome in South Australia 2013page 50
Mothers and Babies
III. Terminations of Pregnancy
1. Numbers and rates
There were 4,681 terminations of pregnancy notified in South Australia in 2013, 84 fewer than in 2012. There were
14.4 terminations of pregnancy per 1,000 women aged 15-44 years. Following the introduction of specific legislation
in 1970, the pregnancy termination rate rose to a peak of 13.9 in 1980, followed by a period of relative stability in the
1980s, with another increase commencing in 1991 which reached a peak of 17.9 in 1999 (Table 1 and Figure 1). The
rate declined considerably from 17.7 in 2001 to 15.3 in 2005. Since 2012 it has continued to decline.
Table 37: Number* of pregnancy terminations, and rate per 1,000 women aged 15-44 years, South
Australia, 1970-2013
Year Number Rate Year Number Rate
1970 1,440 6.0 1992 4,717 14.2
1971 2,409 9.6 1993 4,959 15.0
1972 2,692 10.6 1994 5,140 15.7
1973 2,847 11.1 1995 5,475 16.9
1974 2,867 10.9 1996 5,545 17.2
1975 3,000 11.1 1997 5,609 17.5
1976 3,289 11.9 1998 5,488 17.2
1977 3,494 12.4 1999 5,679 17.9
1978 3,895 13.6 2000 5,580 17.6
1979 3,880 13.3 2001 5,579 17.7
1980 4,081 13.9 2002 5,467 17.5
1981 4,096 13.7 2003 5,216 16.7
1982 4,061 13.4 2004 4,931 15.9
1983 4,036 13.1 2005 4,715 15.3
1984 4,091 13.1 2006 4,889 15.5
1985 4,079 12.9 2007 4,885 15.4
1986 4,327 13.5 2008 5,101 16.0
1987 4,229 13.1 2009 5,057 15.6
1988 4,263 13.0 2010 5,048 15.5
1989 4,342 13.2 2011 5,010 15.5
1990 4,463 13.4 2012 4,765 14.7
1991 4,496 14.1 2013 4,681 14.4
*The corrected total numbers of pregnancy terminations notified for the years 1970 to 2012 are shown in Table 37
Figure 7: Pregnancy termination rate per 1,000 women aged 15-44 years, South Australia, 1970-2013
0
4
8
12
16
20
19
70
19
71
19
72
19
73
19
74
19
75
19
76
19
77
19
78
19
79
19
80
19
81
19
82
19
83
19
84
19
85
19
86
19
87
19
88
19
89
19
90
19
91
19
92
19
93
19
94
19
95
19
96
19
97
19
98
19
99
20
00
20
01
20
02
20
03
20
04
20
05
20
06
20
07
20
08
20
09
20
10
20
11
20
12
20
13
Pe
r
1,
00
0
w
o
m
en
a
g
ed
1
5-
44
y
ea
rs
Year
Pregnancy Outcome in South Australia 2013 page 51
Terminations of Pregnancy
2. Age of women
The age distribution of women who had pregnancies terminated is shown in Table 38. Among the five- year age
groups (Table 39), the highest pregnancy termination rate was among women aged 20-24 years (22.8 per 1,000
women) followed by women aged 25-29 years (20.7 per 1,000 women). Pregnancy termination rates continued to
fall for teenage women, from 13.7 in 2012 to 12.2 per 1,000 women in 2013. The teenage pregnancy rate (including
live births and induced abortions) continued to decline, and in 2013 was the lowest on record for the state at 25.3
per 1,000 women aged 15-19 years compared with 29.1 in 2012. The abortion proportion (induced abortion as a
proportion of induced abortions and live births) was 0.19; it was highest among teenagers (0.48), and was also high
among women aged 20-24 years (0.30) and older women aged over 45 years (0.23). This indicated that about 48%
of known teenage pregnancies were terminated. This proportion was highest for younger teenagers (0.60 for those
aged <15 years).
Table 38: Terminations of pregnancy by age, South Australia, 2013
Age (years) Number
% of terminations
under 20 years % of all terminations
11 1 0.2 0.0
12 2 0.3 0.0
13 1 0.2 0.0
14 11 1.8 0.2
15 23 3.7 0.5
16 70 11.3 1.5
17 114 18.3 2.4
18 166 26.7 3.5
19 234 37.6 5.0
Sub-total 622 100.0 13.3
Under 15 15 0.3
15-19 607 13.0
20 24 1,271 27.2
25 29 1,167 24.9
30 34 838 17.9
35 39 539 11.5
40 44 214 4.6
45 and over 30 0.6
Total 4,681 100.0
The age distribution of pregnancy terminations and live births by age in South Australia in 2013 (Table 39 and Figure
8a) demonstrated that the largest proportion of pregnancy terminations occurred in the age group 20-24 years
(22.8 per 1,000 women), while the largest proportion of live births occurred among those 30-34 years, who had
the highest fertility (live birth) rate of 124.7 per 1,000 women. Teenagers accounted for 13.3% of women who had
pregnancies terminated and 3.3% of women who had live births in South Australia in 2013. The teenage pregnancy
rate continued to decline and was associated with a decline in both the teenage birth and teenage pregnancy
termination rate (Figure 8b). The teenage pregnancy rate in 2013 was 25.3 per 1,000 women aged 15-19 years, and
was the lowest rate recorded since 1970.
Pregnancy Outcome in South Australia 2013page 52
Terminations of Pregnancy
Table 39: Termination of pregnancy and live birth rates and termination of pregnancy proportions by age,
South Australia, 2013
Age
(years)
Number
of
termination
of pregnancy
Estimated
resident female
population
August 4 2012*
Termination
of pregnancy
rate per
1,000 women
Number of
live births#
Fertility
rate
per 1,000
women
Termination
of
pregnancy
+ live births
Abortion
proportion
<15 15 na na 10 na 25 0.60
15-19 607 50,918 12.2 656 13.1 1263 0.48
20-24 1271 55,868 22.8 2897 51.9 4168 0.30
25-29 1167 56,460 20.7 5900 104.5 7067 0.17
30-34 838 53,325 15.7 6650 124.7 7488 0.11
35-39 539 51,246 10.5 3204 62.5 3743 0.14
40-44 214 58,198 4.2 772 13.8 986 0.22
45+ 30 na 31 na 61 0.49
Total 4,681 326,015 14.4 20,120 61.7 24,801 0.19
*Australian Bureau of Statistics. Population Estimates by Age and Sex, South Australia 2013. Canberra: ABS, 2014 (Catalogue No 3235.0).
#Terminations of pregnancy are excluded from the numbers of live births.
The termination of pregnancy and live birth rates for women aged 15-19 years include terminations and live births at younger ages, and the rates for
women aged 40-44 years include terminations and live births at older ages, while the total rates include all terminations and live births.
Figure 8a: Termination of pregnancy and live births by age, South Australia, 2013
0%
20%
40%
60%
80%
100%
Abortions Live births Abortions & Live births
Pe
rc
en
ta
g
e
o
f
w
o
m
en
Age (years)
40+ 35-39 30-34 25-29 20-24 <20
n=4,681 n=20,120 n=24,801
Pregnancy Outcome in South Australia 2013 page 53
Terminations of Pregnancy
Figure 8b: Teenage pregnancy, termination of pregnancy and birth rates, South Australia, 1970-2013
0
10
20
30
40
50
60
19
70
19
71
19
72
19
73
19
74
19
75
19
76
19
77
19
78
19
79
19
80
19
81
19
82
19
83
19
84
19
85
19
86
19
87
19
88
19
89
19
90
19
91
19
92
19
93
19
94
19
95
19
96
19
97
19
98
19
99
20
00
20
01
20
02
20
03
20
04
20
05
20
06
20
07
20
08
20
09
20
10
20
11
20
12
20
13
R
at
e
p
er
1
,0
00
w
o
m
en
a
g
ed
1
5-
19
y
ea
rs
Year
Abortion rate* Birth rate* Pregnancy rate*
*Abortions and births to women aged less than 15 years are included in the numerator
3. Place of residence and place where termination performed
The proportion of women who were country residents (18.7%) was similar to previous years. As in previous years,
the proportion of pregnancy terminations performed in country hospitals (2.2%) was lower, relative to the proportion
of country residents having terminations, indicating that the majority of country residents have their terminations in
metropolitan hospitals (Table 40).
Table 40: Terminations by place of residence, South Australia, 2013
Residence of women Number %
Metropolitan 3,790 81.3
Country 874 18.7
Total 4,664 100.0
As in previous years, the vast majority of terminations (97.0%) were performed in metropolitan public hospitals,
including 59.2% (2,771) at the Pregnancy Advisory Centre (Table 41).
Table 41: Terminations by hospital category, South Australia, 2013
Hospital where termination performed Number %
Metropolitan public 4,540 97.0
Metropolitan private 40 0.9
Country 101 2.2
Total 4,681 100.0
Doctors in family advisory clinics in teaching hospitals and the Pregnancy Advisory Centre performed 77.1% of
the terminations. Elsewhere, obstetricians and trainee obstetricians performed 21.2%, while general practitioners
performed 1.6% (Table 42).
Pregnancy Outcome in South Australia 2013page 54
Terminations of Pregnancy
Table 42: Terminations by category of doctor, South Australia, 2013
Category of doctor performing termination Number %
Medical practitioner in family advisory clinic 3,611 77.1
Obstetrician/gynaecologist 674 14.4
Trainee obstetrician/gynaecologist 319 6.8
General practitioner 77 1.6
Total 4,681 100.0
4. The reason for termination
The pattern of reasons for termination of pregnancy remained similar to previous years, with 96.1% being performed
for the woman s mental health, 3.4% for serious handicap of the fetus and 0.6% for specified medical conditions. Of
the 157 terminations for fetal reasons, 69 were for chromosomal abnormalities and 82 for other fetal abnormalities
detected or suspected prenatally. Six were performed for exposure during pregnancy to drugs, which may cause fetal
abnormalities (Table 43).
Table 43: Reason for termination for fetal reasons, South Australia, 2013
Reason for termination Number %
Identified chromosomal abnormality 82 52.2
Other identified fetal abnormality 69 43.9
Possibility of damage from drugs 6 3.8
Total 157 100.0
5. Gestation, method and complications
The majority of terminations (91.9%) were performed within the first 14 weeks of pregnancy and most frequently (in
50.4% of cases) by vacuum aspiration. There were 94 terminations performed at 20 weeks gestation or later: 50.0%
of these were performed for fetal reasons.
Tables 44a and 44b report complications by the number of women undergoing termination procedures (4,681), which
included one failed procedure.
There were 115 (2.5%) women who experienced complications related to a pregnancy termination. Fourteen (12.2%)
of these were reported on the abortion notification form, and 101 (87.8%) were identified through validation with
hospital admission statistics from the South Australian hospital morbidity collection, using codes for pregnancy
termination for women admitted in to hospital. The notification form tends to identify more immediate complications.
The main complication reported was retained products of conception (99 cases). Of the 77 women with complications
reported following termination with mifepristone +/- misoprostol, 74 (96.1%) were due to retained products.
Pregnancy Outcome in South Australia 2013 page 55
Terminations of Pregnancy
Table 44a: Complications of termination procedures, South Australia, 2013
Complication
Number of
complications % of complications
% of all termination
procedures
Retained products of conception 99 86.1 2.1
Uterine infection 8 7.0 0.2
Bleeding 1 0.9 0.0
Sepsis 1 0.9 0.0
Haemorrhage post-operative 1 0.9 0.0
Haemorrhage intra-operative 1 0.9 0.0
Failed procedure 1 0.9 0.0
Other 3 2.6 0.1
Total 115 100.0 2.5
Table 44b: Complications by method of termination procedure, South Australia, 2013
Method of termination
Number of women
with complications
Number of
termination procedures
% of termination
procedure with
complications by method
Mifepristone +/- Misoprostol 77 1,245 6.2
Vacuum aspiration 20 2,358 0.8
Dilatation and curettage 7 629 1.1
Cervagem / Misoprostol 5 38 13.2
Dilatation and evacuation 3 384 0.8
Misoprostol 3 26 11.5
Other 0 1 0.0
Total 115 4,681 2.5
Pregnancy Outcome in South Australia 2013page 56
Terminations of Pregnancy
6. Previous terminations. Total termination of pregnancy rate and total first
termination of pregnancy rate
Of the 4,681 women who had terminations, 1,684 (36.0%) had undergone a previous termination (Table 45a).
Among the teenagers 14.3% had a previous termination; 31.4% of women aged 20-24 years and 46.8% of women
aged 35-39 years had undergone a previous termination.
The total induced abortion rate (TAR) is the sum of pregnancy termination rates for each of the five-year age groups
multiplied by five. This can be calculated using the rates in Table 39 and in 2013 was 430.3 per 1,000 women aged
15-44 (Table 45b). This represents the number of induced abortions 1,000 women would have during their lifetime if
they experienced the induced abortion rates of the different age groups for 2013.
A woman may have more than one termination of pregnancy in her lifetime, and to estimate how prevalent
termination of pregnancy is at these age-specific induced abortion rates, a total first induced abortion rate (TFAR,
Table 45c) may be calculated after excluding women with repeat terminations. The TFAR for 2013 was 276.1 per
1,000 women aged 15-44 years. This suggests that 27.6% of women would have a termination of pregnancy in their
lifetime if they experienced the termination of pregnancy rates of the different age groups for 2013.
Table 45a: Women with previous terminations by age, South Australia, 2013
Age (years) Number % of age group % of all terminations
< 15 0 0.0 0.0
15 - 19 87 5.2 1.9
20 - 24 399 23.7 8.5
25 - 29 489 29.0 10.4
30 - 34 350 20.8 7.5
35 - 39 252 15.0 5.4
40+ 107 6.4 2.3
Total 1,684 100.0 36.0
Further details of termination of pregnancy in South Australia in 2013 may be obtained from the Eleventh Annual
Report of the South Australian Abortion Reporting Committee for the year 2013.6
Pregnancy Outcome in South Australia 2013 page 57
Terminations of Pregnancy
Table 45b: Calculation of total induced abortion rate (TAR), South Australia, 2013*
Age (years)
Number of women
who had terminations
Estimated female resident
population 30 June 2013
Termination of pregnancy
rate per 1,000 women
15-19* 622 51,239 12.2
20-24 1,271 56,050 22.8
25-29 1,167 56,064 20.7
30-34 838 51,702 15.7
35-39 539 52,013 10.5
40-44* 244 58,138 4.2
Total 4,681 325,206 14.4
*In these calculations, termination of pregnancy for women under 15 years are included in the age group 15-19 yrs and termination of pregnancy for
women aged 45 years or more are included in the age group 40-44 years, as is traditional.
Total induced abortion rate (TAR) = sum of termination of pregnancy rates for 5-year age groups x 5 = 86.1 x 5 = 430.3 per 1,000 women aged
15-44 years.
Table 45c: Calculation of total first induced abortion rate (TFAR), South Australia, 2013
Age
(years)
Number of
women who had
terminations
(A)
Number of women
who had previous
terminations
(B)
Number of women
who had first
termination
(A) (B)
Estimated
female resident
population
30 June 2013*
First termination
of pregnancy
rate per 1,000
women
15-19 622 87 535 50,918 10.5
20-24 1,271 399 872 55,868 15.6
25-29 1,167 489 678 56,460 12.0
30-34 838 350 488 53,325 9.2
35-39 539 252 287 51,246 5.6
40-44 244 107 137 58,198 2.4
Total 4,681 1,684 2,997 326,015 9.2
* Australian Bureau of Statistics. Population Estimates by Age and Sex, South Australia 30 June 2013. Canberra: ABS, 2014 (Catalogue No 3235.0).
In these calculations, termination of pregnancy for women under 15 years are included in the age group 15-19 years and termination of pregnancy for
women aged 45 years or more are included in the age group 40-44 years.
Total first induced abortion rate (TFAR) = sum of first termination of pregnancy rates for 5-year age groups x 5 = 55.2 x 5 = 276.1 per 1,000 women
aged 15-44 yrs.
Pregnancy Outcome in South Australia 2013page 58
Terminations of Pregnancy
IV. Obstetric Profiles by Hospital Category
Obstetric profiles for the three major metropolitan public hospitals and three hospital categories for 2013 are provided
in Table 46 and Figures 9-28. They were also reported for hospital categories and individual hospitals in the Pregnancy
and Neonatal Care Bulletins.
These hospital categories as determined by their Perinatal Service Delineation are:
1. The Women s & Children s Hospital,
2. Flinders Medical Centre, (both the Women s and Children s Hospital and Flinders Medical Centre have neonatal
intensive care facilities)
3. The Lyell McEwin Hospital,
4. Metropolitan private hospitals,
5. The two Level 4:4 country hospitals (Mount Gambier and Port Augusta) and
6. Other country hospitals (Perinatal Service Delineation of 3:3).
One mother who gave birth at the Royal Adelaide Hospital has been excluded from these hospital category statistics.
A list of maternal and baby factors identified either as risk factors for poor perinatal outcome in earlier analyses, 7 or
of general interest, is provided with means for all state hospital births as well as proportions for the six hospital
categories.
The mean is the proportion for women who gave birth in all state hospitals (for maternal factors) or births in all
state hospitals (for baby factors),
e.g. % Aboriginal women
x100
Total number of women who gave birth in state hospitals
Number of Aboriginal women who gave birth in state hospitals
Where indicated (+) in Table 46, it is the mean (number of women who gave birth, or births) for the 22 hospitals
or groups of hospitals for which obstetric profiles have been provided, and which have also been included in the
provision of the 10th and 90th percentile values. These are as follows:
1. Women s & Children s Hospital
2. Flinders Medical Centre
3. Lyell McEwin Hospital
4. Ashford Hospital
5. Burnside War Memorial Hospital Inc
6. Calvary Healthcare Adelaide
7. Flinders Private Hospital
8. North Eastern Community Hospital
9. Mount Gambier & District Health Service Inc
10. Port Augusta Hospital & Regional Health Service Inc
11. Barossa Health (Tanunda Centre)
12. Gawler Health Service
13. Loxton Hospital
14. Mount Barker District Soldiers Memorial Hospital Inc
15. Murray Bridge Soldiers Memorial Hospital Inc
16. Naracoorte Health Service Inc
17. Northern Yorke Peninsula Regional Health Service (Wallaroo)
Pregnancy Outcome in South Australia 2013 page 59
Obstetric Profiles by Hospital Category
18. Port Lincoln Health Service Inc
19. Port Pirie Regional Health Service Inc
20. Riverland General Hospital (Berri)
21. The Whyalla Hospital & Health Services Inc
22. Country hospitals with <100 births per year
The 10th percentile is the proportion below which 10% of the 22 hospital proportions, i.e. the two lowest hospital
proportions, would be found if the 22 proportions were ranked from highest to lowest. The 90th percentile is the
proportion above which 10% of the 22 hospital proportions, i.e. the two highest proportions, would be found if the
22 proportions were ranked from highest to lowest. As the two Level III hospitals which account for 41.8% of hospital
births have proportions of some factors (such as prolonged hospitalisation and use of neonatal intensive care) which
are much greater than for the other 20 hospitals, occasionally the mean for all hospitals will be seen to be higher than
the 90th percentile.
The table and figures provide obstetric profiles for the three major metropolitan public hospitals and three hospital
categories. These have been provided since 1986 to hospitals with 100 or more births per year, together with their
individual hospital profiles, including crude and standardized perinatal mortality ratios,8 the latter with exclusion of
perinatal deaths from congenital abnormalities3 and terminations of pregnancy. For country hospitals with less than
100 births per year, a group report has been provided.
Each hospital s statistics for each factor may be compared with those for state hospitals and for categories of
hospitals, e.g. whether a hospital s proportion for any factor falls within the range of the more common proportions
prevailing in hospitals in the state (i.e. between the 10th and the 90th percentiles).
Pregnancy Outcome in South Australia 2013page 60
Obstetric Profiles by Hospital Category
Table 46: Obstetric profiles by hospital category, South Australia, 2013: live births and stillbirths of >=400g
or >=20 weeks gestation#
Factors
All state hospitals Metropolitan hospitals Country hospitals
Mean 10th percentile
90th
percentile W&CH FMC LMH Private
Level
4:4 Other
Maternal factors
Women (n= 19,810) 900+ 143 3,298 4,740 3,322 3,298 4,543 852 3,055
% Aboriginal women 3.6 0.2 9.8 4.4 2.8 4.5 0.2 11.9 5.1
% Antenatal visits <7* 8.7 0.7 12.0 14.7 12.0 11.7 0.6 6.6 5.5
% Teenage women 3.4 0.0 10.3 2.7 4.0 5.6 0.0 4.3 5.8
% Women ?35 years 19.7 10.5 29.4 21.4 16.5 12.2 30.8 13.7 13.9
% Single women 10.2 1.7 17.8 16.3 8.8 13.3 1.7 12.7 10.5
% 4+ prior live births 2.9 0.4 6.3 3.5 2.0 5.3 0.5 4.9 3.7
% 1+ prior perinatal deaths 1.3 0.6 1.7 1.9 1.4 1.7 0.7 0.5 1.1
% Obstetric complications 39.6 23.4 44.6 44.6 52 44.5 29.9 39.9 27.5
% Labour complications 38.1 25.0 38.6 48.7 49.4 38.6 25.7 27.3 30.2
% Induction 32.7 25.2 36 36 31.4 30.7 34.8 32 28.1
% Emergency caesarean 17.9 9.9 22.1 18.6 20.9 18.5 17.1 16.4 14.4
% Elective caesarean 16.3 11.8 23.3 11.7 16.0 14.0 24.5 17.0 14.1
% Total caesarean 34.2 26.2 42.6 30.2 36.9 32.5 41.6 33.5 28.4
% Ultrasound
examination* 97.6 94.2 98.6 98.6 99.0 98.2 96.5 95.8 96.1
% Amniocentesis* 3.4 0.9 4.4 5.0 2.6 2.9 3.6 2.9 2.2
% Episiotomy 13.4 4.0 17.2 15.5 12.4 12.7 17.0 5.4 8.8
% Repair of perineal tear 26.6 18.2 32.4 32.5 25.1 22.4 27.0 21.8 24.6
% Epidural analgesia 31.5 13.8 43.4 37.3 26.1 26.5 43.7 19.2 18.9
% Spinal analgesia 1.0 0.0 1.7 0.5 0.8 1.4 1.2 0.7 1.3
% Private patients 27.2 1.3 100.0 7.3 1.3 1.1 100.0 17.8 9.0
% Primiparous women 43.5 35.1 47.0 46.6 47 39.6 45.6 38.6 37.2
% Previous caesarean 17.5 13.8 22.4 15.7 16.4 17.1 21.2 18.2 16.2
% PPH 12.5 3.4 15.4 20.6 12.7 13.6 5.4 8.6 10.0
Baby factors
Births (n= 20,148) 916+ 143 3333 4,891 3,384 3,333 4,622 860 3,058
% Birthweight <2,500g 7.7 0.8 7.5 14.4 9.9 6.2 4.2 5.5 2.0
% Gestational age
<37 weeks at birth 9.8 0.9 9.4 16.8 12.5 8.9 7.0 7.4 1.6
% Prolonged
hospitalisation (>27 days) 2.4 0.0 2.8 5.6 3.8 0.8 1.1 1.2 0.1
% Neonatal intensive
care (Level III or W&CH
paediatric intensive care)
2.8 0.0 2.4 6.4 4.5 1.0 1.0 1.0 0.6
% Birth defect 2.8 0.7 3.0 5.1 2.5 2.8 1.3 2.7 1.7
* adjusted for missing values
+ mean number of women who gave birth, or mean number of births for the 22 hospitals or groups of hospitals
# 1 mother who gave birth at the RAH has been excluded from this table
Pregnancy Outcome in South Australia 2013 page 61
Obstetric Profiles by Hospital Category
Figure 9: Percentage of Aboriginal women by hospital category
0
2
4
6
8
10
12
14
1 2 3 4 5 6
Pe
rc
en
ta
g
e
Hospital category
90th percentile
Mean
10th percentile
Figure 10: Percentage of women with <7 antenatal visits by hospital category
0.0
2.0
4.0
6.0
8.0
10.0
12.0
14.0
16.0
1 2 3 4 5 6
Pe
rc
en
ta
g
e
Hospital category
90th percentile
Mean
10th percentile
Figure 11: Percentage of teenage women by hospital category
0.0
2.0
4.0
6.0
8.0
10.0
12.0
1 2 3 4 5 6
Pe
rc
en
ta
g
e
Hospital category
90th percentile
Mean
10th percentile
Pregnancy Outcome in South Australia 2013page 62
Obstetric Profiles by Hospital Category
Figure 12: Percentage of women 35 years or more by hospital category
0.0
5.0
10.0
15.0
20.0
25.0
30.0
35.0
1 2 3 4 5 6
Pe
rc
en
ta
g
e
Hospital category
90th percentile
Mean
10th percentile
Figure 13: Percentage of single women by hospital category
0.0
2.0
4.0
6.0
8.0
10.0
12.0
14.0
16.0
18.0
20.0
1 2 3 4 5 6
Pe
rc
en
ta
g
e
Hospital category
90th percentile
Mean
10th percentile
Figure 14: Percentage of women with 4 or more prior livebirths by hospital category
0.0
1.0
2.0
3.0
4.0
5.0
6.0
7.0
8.0
1 2 3 4 5 6
Pe
rc
en
ta
g
e
Hospital category
90th percentile
Mean
10th percentile
Pregnancy Outcome in South Australia 2013 page 63
Obstetric Profiles by Hospital Category
Figure 15: Percentage of women with 1 or more prior perinatal deaths by hospital category
0.0
0.5
1.0
1.5
2.0
2.5
1 2 3 4 5 6
Pe
rc
en
ta
g
e
Hospital category
90th percentile
Mean
10th percentile
Figure 16: Percentage of women with obstetric complications by hospital category
0.0
10.0
20.0
30.0
40.0
50.0
60.0
1 2 3 4 5 6
Pe
rc
en
ta
g
e
Hospital category
10th percentile
90th percentile
Mean
Figure 17: Percentage of women with complications during labour or birth by hospital category
0.0
10.0
20.0
30.0
40.0
50.0
60.0
1 2 3 4 5 6
Pe
rc
en
ta
g
e
Hospital category
90th percentile
Mean
10th percentile
Pregnancy Outcome in South Australia 2013page 64
Obstetric Profiles by Hospital Category
Figure 18: Percentage of women with induction of labour by hospital category
0.0
10.0
20.0
30.0
40.0
1 2 3 4 5 6
Pe
rc
en
ta
g
e
Hospital category
90th percentile
Mean
10th percentile
Figure 19: Percentage of women having epidural analgesia by hospital category
0.0
10.0
20.0
30.0
40.0
50.0
1 2 3 4 5 6
Pe
rc
en
ta
g
e
Hospital category
90th percentile
Mean
10th percentile
Figure 20: Percentage of breech births by hospital category
0
0.1
0.2
0.3
0.4
0.5
0.6
0.7
0.8
0.9
1
1 2 3 4 5 6
Pe
rc
en
ta
g
e
Hospital category
90th percentile
Mean
10th percentile
Pregnancy Outcome in South Australia 2013 page 65
Obstetric Profiles by Hospital Category
Figure 21: Percentage of emergency caesarean sections by hospital category
0.0
5.0
10.0
15.0
20.0
25.0
1 2 3 4 5 6
Pe
rc
en
ta
g
e
Hospital category
90th percentile
Mean
10th percentile
Figure 22: Percentage of elective caesarean sections by hospital category
0.0
5.0
10.0
15.0
20.0
25.0
30.0
1 2 3 4 5 6
Pe
rc
en
ta
g
e
Hospital category
90th percentile
Mean
10th percentile
Figure 23: Percentage of total caesarean sections by hospital category
0.0
5.0
10.0
15.0
20.0
25.0
30.0
35.0
40.0
45.0
1 2 3 4 5 6
Pe
rc
en
ta
g
e
Hospital category
90th percentile
Mean
10th percentile
Figure 24: Percentage of births with birthweight below 2,500g by hospital category
0.0
2.0
4.0
6.0
8.0
10.0
12.0
14.0
16.0
1 2 3 4 5 6
Pe
rc
en
ta
g
e
Hospital category
90th percentile
Mean
10th percentile
Pregnancy Outcome in South Australia 2013page 66
Obstetric Profiles by Hospital Category
Figure 25: Percentage of births with gestation less than 37 weeks by hospital category
0.0
2.0
4.0
6.0
8.0
10.0
12.0
14.0
16.0
18.0
1 2 3 4 5 6
Pe
rc
en
ta
g
e
Hospital category
90th percentile
Mean
10th percentile
Figure 26: Percentage of births with prolonged hospitalisation by hospital category
0
1
2
3
4
5
6
1 2 3 4 5 6
Pe
rc
en
ta
g
e
Hospital category
10th percentile
90th percentile
Mean
Figure 27: Percentage of live births requiring neonatal intensive care by hospital category
0
1
2
3
4
5
6
1 2 3 4 5 6
Hospital category
Pe
rc
en
ta
g
e
Mean
10th percentile
90th percentile
Figure 28: Percentage of births with birth defects by hospital category
1 2 3 4 5 6
Hospital category
0
1
2
3
4
5
Pe
rc
en
ta
g
e
10th percentile
90th percentile
Mean
Pregnancy Outcome in South Australia 2013 page 67
Obstetric Profiles by Hospital Category
V. Clinical and Maternity Performance Indicators
1. Clinical indicators
Ten national core maternity indicators have been developed to examine trends in maternity interventions and
outcomes and the quality of maternity services in the years after the introduction of the National Maternity Services
Plan. 9 This report presents these indicators with 95% Confidence Intervals (CI) for South Australian births in 2013.
They were also reported for individual hospitals in the Pregnancy and Neonatal Care Bulletin 2013. Indicator
specifications are in accordance with the 2013 National Core Maternity Indicators report. 10
For the purpose of Indicators 5, 6 and 8 selected primiparae was defined as:
> a woman who was 20-34 years of age at the time of giving birth
> giving birth for the first time at ?20 weeks of gestation
> singleton pregnancy
> cephalic presentation
> at 37 to 41 weeks gestation.
INDICATOR 1: Smoking in pregnancy
Description: This indicator has two parts: (a) among all women who gave birth, the proportion who reported smoking
tobacco at any time within the first 20 weeks of pregnancy; and (b) among women who reported smoking, the
proportion who reported smoking after 20 weeks of pregnancy.
Purpose: This indicator is used to monitor public health and assess the effectiveness of smoking cessation advice in the
antenatal period in the antenatal period.
> Clinical indicator 1a: Total number of women smoking in first 20 weeks of pregnancy.
Numerator: The number of women who gave birth and reported smoking tobacco in the first 20 weeks of pregnancy
(n=2,857).
Denominator: The total number of women who gave birth (n=19,925).
Clinical indicator 1a =
2,857 x 100
19,925
=14.3% (95% CI 13.9% - 14.8%).
> Clinical indicator 1b: Proportion of women who smoked in first 20 weeks of pregnancy and continued to
smoke in the second 20 weeks of pregnancy.
Numerator: The number of women who gave birth and reported smoking tobacco in the second 20 weeks of
pregnancy (n= 1,911).
Denominator: The number of women who gave birth who reported smoking tobacco at any time in the pregnancy
(n= 2,857).
Clinical indicator 1b =
1,911 x 100
2,857
= 66.9% (95% CI 65.1% 68.6%).
Pregnancy Outcome in South Australia 2013page 68
Clinical and Maternity Performance Indicators
INDICATOR 2: Antenatal care in the first trimester for all women giving birth
Description: Among all women who gave birth, the proportion who commenced antenatal care in the first trimester
(before 14 weeks gestation).
Purpose: This indicator is used to assess the accessibility of antenatal services.
> Clinical indicator 2: Antenatal care in the first trimester for all women giving birth
Numerator: The number of women who had their first antenatal visit before 14 weeks gestation and went on to give
birth (n=15,240).
Denominator: The number of all women who gave birth (n=19,925).
Clinical indicator 2 =
19,925
15,240 x 100
= 76.5% (95% CI 75.9% - 77.1%).
INDICATOR 3: Episiotomy for women having their first baby and giving birth vaginally
Description: This indicator has two parts among women who had their first baby: (a) the proportion who received an
episiotomy while giving birth vaginally without instruments; and (b) the proportion who received an episiotomy during
an instrumental vaginal birth.
Purpose: This indicator is used to benchmark practice.
> Clinical indicator 3a: Total number of women having their first baby who gave birth vaginally without
instruments and had an episiotomy
Numerator: The number of women having their first baby who had an episiotomy while giving birth vaginally without
instruments (n=735)
Denominator: The number of women having their first baby who gave birth vaginally without instruments (n=3,791)
Clinical indicator 3a =
3,791
735 x 100 = 19.4% (95% CI 18.2% - 20.7%).
> Clinical indicator 3b: Total number of women having their first baby who gave birth vaginally with
instrumental assistance and had an episiotomy
Numerator: The number of women having their first baby who had an episiotomy during a vaginal birth with
instruments (n=1,258)
Denominator: The number of women having their first baby who gave birth vaginally with instruments (n=1,825)
Clinical indicator 3b =
1,825
1,258 x 100 = 68.9% (95% CI 66.8% - 71.0%).
Pregnancy Outcome in South Australia 2013 page 69
Clinical and Maternity Performance Indicators
INDICATOR 4: Apgar score of less than 7 at 5 minutes for births at or after term
Description: The proportion of liveborn term infants with an Apgar score of less than 7 at 5 minutes.
Purpose: This indicator of the condition of the baby after birth provides an outcome measure of intrapartum care and
resuscitation of the newborn.
> Clinical indicator 4: Apgar score of less than 7 at 5 minutes for births at or after term
Numerator: The number of babies born alive at term with an Apgar score less than 7 at 5 minutes (n=221).
Denominator: The number of live babies born at term (n=18,255).
Clinical indicator 4 =
18,255
221 x 100 = 1.2% (95% CI 1.1% - 1.4%).
INDICATOR 5: Induction of labour for selected primiparae
Description: The proportion of all selected primiparae, whose labour was induced.
Purpose: This indicator is used to benchmark practice.
> Clinical indicator 5: Induction of labour for selected women giving birth for the first time
Numerator: The number of selected primiparae who had labour induced (n=2,492).
Denominator: All selected women giving birth for the first time (n=5,961).
Clinical indicator 5 =
5,961
2,492 x 100 = 41.8% (95% CI 40.6% - 43.1%).
INDICATOR 6: Caesarean section for selected primiparae
Description: The proportion of all selected primiparae who gave birth by caesarean section.
Purpose: This indicator is used to benchmark practice.
> Clinical indicator 6: Caesarean section for selected primiparae
Numerator: The number of selected primiparae who gave birth by caesarean section (n=1,714).
Denominator: All selected primiparae (n=5,961).
Clinical indicator 6 =
5,961
1,714 x 100 = 28.8% (95% CI 27.6% - 29.9%).
INDICATOR 7: Normal (non-instrumental) vaginal birth for selected primiparae
Description: The proportion of all selected primiparae, who had a normal (non-instrumental) vaginal birth.
Purpose: This indicator is used to benchmark practice.
> Clinical indicator 7: Normal (non-instrumental) vaginal birth for selected primiparae
Numerator: The number of selected primiparae who had a normal (non-instrumental) vaginal birth (n=2,803).
Denominator: All selected primiparae (n=5,961).
Clinical indicator 7 =
5,961
2,803 x 100 = 47.0% (95% CI 45.8% - 48.3%).
Pregnancy Outcome in South Australia 2013page 70
Clinical and Maternity Performance Indicators
INDICATOR 8: Instrumental vaginal birth for selected primiparae
Description: The proportion of all selected primiparae, who had a vaginal birth with the assistance of instruments.
Purpose: This indicator is used to benchmark practice.
> Clinical indicator 8: Instrumental vaginal birth for selected primiparae
Numerator: The number of selected primiparae who had a vaginal birth with the assistance of instruments (n=1,444).
Denominator: All selected primiparae (n=5,961).
Clinical indicator 8 =
5,961
1,444 x 100
= 24.2% (95% CI 23.2% - 25.3%).
INDICATOR 9: General anaesthetic for women giving birth by caesarean section
Description: The proportion of women who gave birth by caesarean section who received a general anaesthetic.
Purpose: This indicator is used to benchmark anaesthetic care in association with caesarean section.
> Clinical indicator 9: General anaesthetic for women giving birth by caesarean section
Numerator: The number of women who gave birth by caesarean section and had a general anaesthetic (n=400).
Denominator: The total number of women who gave birth by caesarean section (n=6,778).
Clinical indicator 9 =
400 x 100
6,778
= 5.9% (95% CI 5.4% - 6.5%).
INDICATOR 10: Small babies among births at or after 40 weeks gestation
Description: The proportion of babies born at or after 40 weeks gestation who weighed less than 2,750 grams at
birth.
Purpose: This indicator aims to identify intrauterine growth restriction for babies born at or after 40 weeks gestation.
This indicator is used to benchmark practice.
> Clinical indicator 10.1: Small babies among births at or after 40 weeks gestation
Numerator: The number of babies born at or after 40 weeks gestation who weighed less than 2,750 grams at birth
(n=110).
Denominator: The total number of babies born at or after 40 weeks (n=7,148).
Clinical indicator 10 =
110 x 100
7,148
= 1.5% (95% CI 1.3% - 1.9%).
Pregnancy Outcome in South Australia 2013 page 71
Clinical and Maternity Performance Indicators
2. Maternity performance indicators, hospitals with at least 550 births per year
Six clinical indicators are presented below. Five are selected from The Australian Council on Healthcare Standards
( ACHS Clinical Indicator Users Manual Version 2010 ) and are presented for hospitals with at least 550 births per
year. Additionally, the sixth indicator presents the standardized perinatal mortality ratio.
These six indicators are as follows:
1. Proportion of selected primiparae who underwent induction of labour.
This was as defined for Clinical indicator 5 and was 41.9% for the state in 2013 (and 41.8% for state hospitals) in 2013.
2. Caesarean section rate for selected primiparae.
This was as defined for Clinical indicator 6 and was 28.8% for the state (as well as state hospitals) for 2013.
3. VBAC: proportion of women who gave birth vaginally following a previous primary (first) caesarean
section and no intervening births.
Numerator: Total number of women giving birth vaginally following a previous primary caesarean section (n=386).
Denominator: Total number of women giving birth who have had a previous primary caesarean section and NO
intervening pregnancies greater than 20 weeks gestation (n=2,480).
This was as defined as above and was 15.6% for the state (and 15.5% for state hospitals) in 2013.
4. Proportion of selected primiparae with an intact perineum following vaginal birth.
Numerator: Total number of selected primiparae with an intact perineum (n=355).
Denominator: Total number of selected primiparae giving birth vaginally (n=4,247).
This was as defined as above and was 8.4% for the state (and 8.2% for state hospitals) in 2013.
5. TERM NICU: proportion of term babies admitted to neonatal intensive care (NICU) for reasons other than
congenital abnormality.
Numerator: The number of term babies (37 weeks gestation or later) transferred/admitted to a neonatal intensive care
unit for reasons other than congenital abnormality (n=91).
Denominator: The total number of term live babies born (n=18,255).
This was as defined as above and was 0.5% for the state (as well as state hospitals) in 2013.
6. SPMR: Standardized perinatal mortality ratio for all births.
This is as defined8 in the Pregnancy and Neonatal Care Bulletin 2012. It adjusts for the difference between the
distribution of births by birthweight between the hospital and state hospital births. As perinatal mortality is much
higher in babies of low birthweight, this adjustment ensures that a hospital is directly comparable with other hospitals
and state hospitals as a whole if it has a higher proportion of low birthweight babies than state hospital births.
SPMR =
Expected number of deaths
Observed number of deaths
X 100
To obtain the expected number of deaths for a hospital, the state hospital perinatal mortality rate for 2013 for each
of the birthweight groups in Table 28a is applied to the number of births in each corresponding birthweight group
for the hospital. This gives an expected number of deaths in each birthweight group. These expected deaths are then
totalled to give a total number of expected deaths for the hospital.
SPMRs provided in this report exclude deaths attributed to congenital abnormalities (as determined by the Maternal,
Perinatal and Infant Mortality Committee3), which are the least preventable, as well as terminations of pregnancy.
An SPMR above 100 means that after adjustment for birthweight differences and deaths attributed to congenital
abnormalities and terminations of pregnancy, perinatal mortality for that hospital is higher than that for state hospital
births e.g. an adjusted SPMR of 120 means that it is 20% higher.
Pregnancy Outcome in South Australia 2013page 72
Clinical and Maternity Performance Indicators
A 95% confidence interval (CI) which includes the value 100 in its range means that the hospital s perinatal mortality
is not (statistically) significantly different from that for state hospital births for that year. The SPMRs and 95% CIs for
individual hospitals and categories of hospitals have been programmed using indirect standardization methods.8
Statistics for the six maternity performance indicators for 2013 are provided in Figures 29a 29f for the nine
hospitals, A I, with at least 550 births in 2013. SPMRs for the preceding five years combined, 2009-2013, are
provided in Figure 29G. Metropolitan teaching hospitals and Mount Gambier Hospital have been named with their
permission and are as follows:
A. Women s and Children s
B. Flinders Medical Centre
C. Lyell McEwin Hospital
D. Mt Gambier Hospital
Figure 29a: Induction of labour proportion for selected primiparae, SA hospitals
with >=550 births per year, 2013
0
10
20
30
40
50
A B C D E F G H I
%
Hospital
Induction of labour % *SA hospitals = 41.9%
Figure 29b: Caesarean section rate for selected primiparae, SA hospitals with >=550 births per year, 2013
0
10
20
30
40
50
60
A B C D E F G H I
%
Hospital
Caesarean section % *SA hospitals = 28.8%
Pregnancy Outcome in South Australia 2013 page 73
Clinical and Maternity Performance Indicators
Figure 29c: VBAC: Proportion of women who had a vaginal birth following a previous primary (first)
caesarean section & no intervening births, SA hospitals with >=550 births per year, 2013
0
10
20
30
40
A B C D E F G H I
%
Hospital
VBAC % *SA hospitals = 15.5%
Figure 29d: Proportion of selected primiparae with an intact perineum after a vaginal birth, SA hospitals
with >=550 births per year, 2013
0
10
20
30
40
A B C D E F G H I
%
Hospital
Primip no repair % *SA Hospitals = 8.2%
Figure 29e: TERM NICU: proportion of term babies admitted to NICU for reasons other than congenital
abnormality, SA hospitals with >=550 births per year, 2013
0.0
0.2
0.4
0.6
0.8
1.0
1.2
1.4
A B C D E F G H I
%
Hospital
Term NICU % *SA hospitals = 0.5%
Pregnancy Outcome in South Australia 2013page 74
Clinical and Maternity Performance Indicators
Figure 29f: SPMR (Standardized Perinatal Mortality Ratio) for all births, SA hospitals with >=550 births per
year, 2013
0
50
100
150
200
250
300
A B C D E F G H I
Hospital
SPMR *SA hospitals
Figure 29g: SPMR (Standardized Perinatal Mortality Ratio) for all births, SA hospitals with >=550 births per
year, 2008-2013
0
50
100
150
200
A B C D E F G H I
Hospital
SPMR *SA hospitals
Pregnancy Outcome in South Australia 2013 page 75
Clinical and Maternity Performance Indicators
VI. Trends in Perinatal Statistics in South Australia, 1981-2013
Perinatal statistics are presented in Tables 47 and 48 for both socio-demographic and obstetric aspects for each
year from 2003-2013, as well as for 1981, when the perinatal data collection was commenced. Some features are
illustrated in Fig 30.1 30.8 for the years 1985-2013. The trends noted between 1981 and 2013 are as follows:
1 The total fertility rate was 1.85 live births per woman, following a steady increase from 1.71 in 2000 to 1.91 live
births per woman in 2008, 2009 and 2012.
2 The increase in the proportion of Asian women from 1.8% in 1981 to 12.0% in 2013 and of Aboriginal women
from 1.5% in 1981 to 3.6% in 2013.
3 The decrease in the proportion of teenage women giving birth from 7.8% in 1981 to 3.3% in 2013. Over the
past decade, there has been a general decline in both the teenage birth and abortion rate. The teenage pregnancy
rate in 2013 of 25.3 per 1,000 women was the lowest recorded since 1970, when abortion statistics were first
collected, enabling calculation of a pregnancy rate.
4 The increase in the age of women giving birth. The proportion of women who gave birth who were 35 years or
older increased from 4.6% in 1981 to 19.8% in 2013, following a peak of 21.1% in 2008 and 2009. Amongst
primiparous women the proportion in 1981 was 1.2%, and in 2013 it was 12.4%. (It was 12.8% in 2009). The
mean age among women giving birth increased from 26.55 years in 1981 to peak in 2012 at 30.21 years; in 2013
it was 29.8 years. The mean age among primiparous women which went from 24.42 years in 1981 and peaked in
2012 at 28.44 years remained steady at 28.2 years in 2013.
5 The proportion of single women giving birth peaked in 1996 at 14.9%, since which time there has been a gradual
decrease and was 10.1% in 2013.
6 The proportion of births in country hospitals has gradually declined from 27.8 in 1981 to 24.9% in 1997 and was
19.3% in 2013. The proportion of births in teaching hospitals gradually increased to 57.8% in 2013 following a low of
47.2% in 1991. In 2013 metropolitan private hospitals accounted for 22.8% of births. The number of births in birthing
units in teaching hospitals increased from 125 (0.6%) in 1992 to 1,291 (6.4%) in 2013. Home births increased from
44 (0.2%) in 1997 to 144 (0.7%) in 2010. The decrease in the reporting of homebirths noted in 2011 (64.4%) and
2012 (66.2%) has improved with 107 (84.3%) of an estimated 127 homebirths being reported to the unit.
7 The proportion of multiple births peaked at 3.6% of all births in 2002 and 2003, and in 2013 this proportion was
3.3% of all births.
8 The induction rate increased from 22.1% in 1981 to 32.5% in 2013. Forty-five percent of inductions in 2013 were
performed for other than defined indications.
9 The fall in the proportion of normal spontaneous vaginal births (from 66.1% in 1981 to 53.9% in 2013, breech births
(from 1.1% to 0.5%) and forceps births (from 15.2% to 5.6%). The proportion delivered by ventouse increased from
0.7% to 6.9% in 2010, and was 5.9% in 2013, and by caesarean section, from 16.9% in 1981 to 34% in 2013.
10 The gradual increase in the proportion of low birthweight births (<2,500 grams) from 5.8% in 1981 to 7.7% in
2013. Amongst liveborn babies, the proportion of low birthweight births was 7.1% in 2013, compared with 6.0%
in 1991. The proportion of preterm births also increased from 5.5% in 1981 to 9.8% in 2013.
11 The proportion of births with congenital abnormalities identified before discharge from hospital after birth has
been relatively stable at 2.3%-2.8% during the last decade and was 2.8% in 2013.
12 The increase in the proportion of babies utilising Level II care from 6.7% in 1982 to 16.5% in 2013. The
proportion of babies utilising neonatal intensive care has decreased from 3.3% in 1981 to 2.7% in 2013, while
the proportion using paediatric intensive care remained at 0.2%. The proportion in hospital at 28 days has been
between 2.0% and 2.5% (2.4% in 2013).
14 The considerable fall in the perinatal mortality rate, despite the increasing proportion of preterm births. The
perinatal mortality rate for national statistics (for babies of at least 500g birthweight or 22 weeks gestation
if birthweight unavailable) has fallen from 11.6 in 1981 to 5.2 per 1,000 births in 2013, while the rate for
international statistics (for births of 1,000g or 28 weeks if birthweight unavailable) has fallen from 7.2 to 2.8 per
1,000 births during the same period. The fall in this neonatal mortality rate (for early neonatal deaths) has been
particularly outstanding, reaching 0.5 per 1000 live births in 2013, the lowest recorded in the state being 0.4
per1,000 births in 2012. The fall in perinatal mortality is reflected in the standardized perinatal mortality ratio
which has been calculated in Table 48 for each year utilising perinatal mortality rates for 500g birthweight groups
for the years 1981-1989 combined as the standard. It was 44.3 in 2013 compared with 117.6 in 1981.
Pregnancy Outcome in South Australia 2013page 76
Trends in Perinatal Statistics in South Australia, 1981-2012
Table 47: Socio-demographic aspects of perinatal statistics, South Australia, 1981 and 2004 2013
Characteristic
Year
1981 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013
1 Total births 19,052 17,522 18,196 18,803 19,757 19,970 19,901 20,002 20,344 20,666 20,263
2 Live births 18,905 17,409 18,067 18,663 19,624 19,819 19,761 19,883 20,194 20,528 20,125
3 Women who
gave birth 18,857 17,229 17,897 18,519 19,471 19,672 19,604 19,667 20,043 20,338 19,925
4 Total fertility
rate per
woman
1.75 1.74 1.82 1.82 1.91 1.91 1.87 1.84 1.89 1.91 1.85
5 Place of birth (%)
Teaching hospital 52.2% 49.9% 51.6% 52.1% 52.6% 53.2% 53.7% 54.3% 55.5% 56.8% 57.3%
Private hospital 19.7% 27.2% 26.5% 26.7% 26.6% 26.5% 25.7% 25.6% 24.1% 23.3% 22.8%
Country hospital 27.8% 22.5% 21.6% 20.8% 20.2% 20.3% 19.9% 19.3% 19.9% 19.4% 19.3%
Domiciliary* 0.3% 0.4% 0.3% 0.5% 0.5% 0.5% 0.7% 0.7% 0.5% 0.5% 0.6%
(65) (67) (63) (87) (107) (101) (134) (144) (96) (95) (114)
6 Race (%)
Aboriginal 1.5% 2.8% 2.7% 3.0% 3.0% 3.2% 3.1% 3.2% 3.5% 3.3% 3.6%
(Women who
gave birth) (277) (484) (487) (548) (578) (624) (607) (625) (693) (662) (717)
(Births to
Aboriginal
mothers)
(280) (491) (492) (559) (590) (637) (618) (630) (703) (669) (729)
(Babies identified
as Aboriginal) (904) (952)
Asian 1.8% 4.8% 5.3% 5.1% 6.2% 7.0% 8.1% 9.6% 11.1% 12.1% 12.0%
7 Age
Mean age (years) 26.55 29.81 29.86 30.01 30.05 30.11 30.14 30.14 29.69 30.21 29.8
Teenage (%) 7.8% 5.3% 5.2% 4.8% 4.6% 4.5% 4.1% 4.0% 4.0% 3.9% 3.3%
?35 years (%) 4.6% 17.9% 18.7% 20.4% 20.2% 21.1% 21.1% 20.5% 20.6% 20.4% 19.8%
8 Marital status (%)
Never married 7.6% 11.8% 12.5% 11.7% 11.0% 10.7% 10.0% 9.6% 9.2% 9.2% 8.8%
Widowed/
divorced/
separated (%)
2.0% 1.3% 1.3% 1.3% 1.4% 1.2% 1.2% 1.3% 1.0% 1.3% 1.3%
(Single) (9.6%) (13.0%) (13.8%) (13.0%) (12.5%) (11.9%) (11.2%) (10.9%) (10.2%) (10.5%) (10.1%)
9 Primiparae
Mean age (years) 24.42 28.13 28.02 28.20 28.30 28.24 28.27 28.34 27.92 28.44 28.20
Teenage 15.4% 10.0% 10.1% 9.5% 8.9% 8.8% 8.4% 7.8% 7.8% 7.8% 6.7%
?35 years 1.2% 11.0% 11.4% 12.6% 12.5% 12.7% 12.8% 12.2% 12.0% 11.8% 12.4%
*includes unplanned home births
Pregnancy Outcome in South Australia 2013 page 77
Trends in Perinatal Statistics in South Australia, 1981-2012
Table 48: Obstetric aspects of perinatal statistics, South Australia, 1981 and 2004 2013
Characteristic
Year
1981 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013
1 Plurality
Multiple births
(%) 2.0% 3.3% 3.3% 3.0% 2.9% 3.0% 3.0%
3.3% 2.9% 3.2% 3.3%
Twins (363) (578) (570) (552) (544) (592) (578) (644) (586) (636) (640)
Triplets (21) (6) (21) (12) (21) (3) (12) (15) (12) (15) (27)
Quadruplets (0) (0) (0) (0) (0) (0) (0) (4) (0) (0) (0)
2 Induction of
labour (%) 22.1% 27.9% 28.3% 28.9% 29.8% 28.6% 29.4% 29.6% 31.2% 30.9% 32.5%
3 Method of birth
Normal
spontaneous 66.1% 55.9% 55.8% 56.0% 56.0% 56.0% 55.4% 55.2% 54.7% 54.2% 53.9%
Elective caesarean 8.2% 14.0% 14.6% 15.5% 15.3% 15.4% 15.7% 15.5% 15.8% 15.9% 16.2%
Emerg caesarean 8.7% 17.6% 17.6% 17.4% 17.1% 16.8% 16.7% 16.7% 17.3% 17.9% 17.8%
Forceps 15.2% 5.0% 4.2% 3.7% 4.1% 4.2% 4.6% 5.4% 5.7% 5.5% 5.6%
Breech 1.1% 0.4% 0.4% 0.4% 0.4% 0.5% 0.4% 0.3% 0.5% 0.4% 0.5%
Ventouse 0.7% 7.1% 7.3% 7.0% 7.1% 7.1% 7.2% 6.9% 5.9% 6.0% 5.9%
Total caesarean (16.9%) (31.5%) (32.3%) (32.9%) (32.3%) (32.2%) (32.4%) (32.2%) (33.2%) (33.8%) (34.0%)
4 Birthweight
<2,500g 5.8% 7.0% 7.6% 7.0% 6.9% 7.0% 7.3% 7.2% 7.5% 7.7% 7.7%
Singletons 4.9% 5.3% 5.9% 5.5% 5.5% 5.5% 5.7% 5.6% 6.2% 6.1% 5.8%
Multiples 52.1% 55.8% 57.7% 53.4% 53.6% 53.4% 59.8% 54.1% 51.9% 56.8% 63.0%
5 Gestational age
<37 weeks 5.5% 8.7% 9.0% 8.2% 8.5% 8.6% 9.0%
8.9% 9.2% 9.4% 9.8%
Singletons 4.8% 7.0% 7.3% 6.8% 7.1% 7.0% 7.2% 7.2% 7.5% 7.6% 7.7%
Multiples 41.1% 58.4% 58.4% 54.4% 57.2% 59.3% 67.5% 58.4% 61.5% 64.7% 70.6%
6 Congenital
abnormalities 3.4% 2.5% 2.5% 2.3% 2.6% 2.7% 2.7% 2.8% 3.0% 2.7% 2.8%
7 Level II care Na 16.6% 16.2% 15.3% 16.1% 15.4% 15.3% 16.0% 16.2% 16.7% 16.5%
8 Level III care 3.3% 2.9% 2.9% 2.5% 2.3% 2.5% 2.9% 2.5% 2.6% 2.7% 2.7%
9 W&CH ICU care Na 0.2% 0.3% 0.2% 0.3% 0.3% 0.3% 0.2% 0.2% 0.2% 0.2%
10 Hospitalisation
for 28 days or
more
4.2% 2.3% 2.4% 2.0% 2.1% 2.2% 2.2% 2.0% 2.2% 2.4% 2.4%
11 Neonatal deaths 96 52 63 38 55 51 49 44 44 46 45
12 Stillbirths 147 113 129 140 132 151 140 119 150 138 138
13 Perinatal deaths 243 165 192 178 188+ 202 189 163 194 184 183
14 Perinatal mortality rate per 1,000 births
?400g/20 weeks 12.8 9.4 10.6 9.5 9.5 10.1 9.5 8.1 7.4 8.9 9.0
?500g/22 weeks* 11.6 5.7 6.2 4.9 5.2 5.3 4.9 4.4 5.3 4.1 5.5
?1,000g/28
weeks* 7.2 3.5 3.7 3.1 2.6 3.4 3.5 3.2 3.2 2.1 2.8
15 Standardized
perinatal
mortality ratio
117.6 66.9 66.5 63.0 65.1 67.3 65.2 57.6 52.8 42.6 44.3
* only neonatal deaths within the first 7 days of life are included, as recommended by the World Health Organisation for national and international
statistics.
Pregnancy Outcome in South Australia 2013page 78
Trends in Perinatal Statistics in South Australia, 1981-2012
Trends in Perinatal Statistics in South Australia (SA), 1985 2013
Figure 30.1: Percentage of teenage women among women giving birth in SA
0
2
4
6
8
19
85
19
86
19
87
19
88
19
89
19
90
19
91
19
92
19
93
19
94
19
95
19
96
19
97
19
98
19
99
20
00
20
01
20
02
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03
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04
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05
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20
08
20
09
20
10
20
11
20
12
20
13
Pe
rc
en
ta
g
e
Year
Figure 30.2: Percentage of women aged 35 years and over among women giving birth in SA
0
4
8
12
16
20
24
19
85
19
86
19
87
19
88
19
89
19
90
19
91
19
92
19
93
19
94
19
95
19
96
19
97
19
98
19
99
20
00
20
01
20
02
20
03
20
04
20
05
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06
20
07
20
08
20
09
20
10
20
11
20
12
20
13
Pe
rc
en
ta
g
e
Year
Figure 30.3: Percentage of primiparous women aged 35 years and over in SA
0
5
10
15
19
85
19
86
19
87
19
88
19
89
19
90
19
91
19
92
19
93
19
94
19
95
19
96
19
97
19
98
19
99
20
00
20
01
20
02
20
03
20
04
20
05
20
06
20
07
20
08
20
09
20
10
20
11
20
12
20
13
Pe
rc
en
ta
g
e
Year
Pregnancy Outcome in South Australia 2013 page 79
Trends in Perinatal Statistics in South Australia, 1981-2012
Figure 30.4: Percentage of Aboriginal women and Asian women among women giving birth in SA
0
2
4
6
8
10
12
14
19
85
19
86
19
87
19
88
19
89
19
90
19
91
19
92
19
93
19
94
19
95
19
96
19
97
19
98
19
99
20
00
20
01
20
02
20
03
20
04
20
05
20
06
20
07
20
08
20
09
20
10
20
11
20
12
20
13
Pe
rc
en
ta
g
e
Year
Asian Aboriginal
Figure 30.5: Percentage of women never married and with no de facto partner among women giving birth
in SA
0
3
6
9
12
15
19
85
19
86
19
87
19
88
19
89
19
90
19
91
19
92
19
93
19
94
19
95
19
96
19
97
19
98
19
99
20
00
20
01
20
02
20
03
20
04
20
05
20
06
20
07
20
08
20
09
20
10
20
11
20
12
20
13
Pe
rc
en
ta
g
e
Year
Figure 30.6: Percentage of multiple births among births in SA
0
1
2
3
4
19
85
19
86
19
87
19
88
19
89
19
90
19
91
19
92
19
93
19
94
19
95
19
96
19
97
19
98
19
99
20
00
20
01
20
02
20
03
20
04
20
05
20
06
20
07
20
08
20
09
20
10
20
11
20
12
20
13
Pe
rc
en
ta
g
e
Year
Pregnancy Outcome in South Australia 2013page 80
Trends in Perinatal Statistics in South Australia, 1981-2012
Figure 30.7 Percentage of low birthweight babies among births in SA
0
2
4
6
8
19
85
19
86
19
87
19
88
19
89
19
90
19
91
19
92
19
93
19
94
19
95
19
96
19
97
19
98
19
99
20
00
20
01
20
02
20
03
20
04
20
05
20
06
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07
20
08
20
09
20
10
20
11
20
12
20
13
Pe
rc
en
ta
g
e
Year
Figure 30.8: SA standardised perinatal mortality ratio (SPMR)
0
50
100
150
19
85
19
86
19
87
19
88
19
89
19
90
19
91
19
92
19
93
19
94
19
95
19
96
19
97
19
98
19
99
20
00
20
01
20
02
20
03
20
04
20
05
20
06
20
07
20
08
20
09
20
10
20
11
20
12
20
13
SP
M
R
Year
Pregnancy Outcome in South Australia 2013 page 81
Trends in Perinatal Statistics in South Australia, 1981-2012
VII. Summary Statistics for 2013
These statistics refer to all live births as well as stillbirths of at least 400g birthweight or 20 weeks gestation. Fifty
babies of less than 400g birthweight have been included.
1. Number of births
Reported number of births (from monthly notifications): 20,263
Notified births with Supplementary Birth Records: 20,263
Notified women who gave birth with SBRs: 19,925
Crude birth rate: 12.0 live births per 1,000 population.
Total fertility rate: 1.85 live births per woman
2. Place of birth
Home births: 114 home births in all (0.6%), of which 107 were planned home births (0.5% of births in the state).
Metropolitan teaching hospitals: 11,609 (57.3%)
Metropolitan private hospitals: 4,622 (22.8%)
Country hospitals: 3,918 (19.3%)
3. Sex
Males 10,531, Females 9,731. Male: Female sex ratio = 1.08:1
4. Plurality and condition at birth
Condition at birth
Plurality
TotalSingleton Twins Triplets
Live birth 19,462 636 27 20,125
Stillbirth 134 4 0 138
Total 19,596 640 27 20,263
5. Race of women
Race Number of women %
Caucasian 15,600 78.3
Aboriginal 717 3.6
Asian 2,394 12.0
Other 1,214 6.1
Total 19,925 100.0
Pregnancy Outcome in South Australia 2013page 82
Summary Statistics for 2012
6. Obstetric interventions in 19,925 women who gave birth
Induction of labour was performed for 6,476 women (32.5%) and labour was augmented for another 3,530 women
(17.7%) who gave birth.
Forceps were utilised for 1,127 women (5.7%), ventouse in 1,127 (5.7%) and episiotomy was performed for 1,175
women who gave birth (12.6%, or 19.1% of women who gave birth vaginally).
Caesarean section was performed in 6,778 women who gave birth (34%), of which 3,237 (16.2%) were elective, and
3,541 (17.8%) emergency operations.
7. Low birthweight (<2,500g)
Number of singleton births of low birthweight =1,132 (5.8% of singleton births).
Number of multiple births of low birthweight =420 (63% of multiple births).
Number of all births of low birthweight =1,552 (7.7% of all births).
8. Congenital anomalies
Births notified with congenital anomalies: 565 (2.8%).
9. Perinatal mortality rates (numbers of deaths in parentheses)
Birthweight/Gestation Stillbirth rate per 1,000 births
Neonatal death rate per
1,000 live births
Perinatal mortality rate
per 1,000 births
1 ?400g/20 weeks (138) 6.8 (45) 2.2 (183) 9.0
2 ?500g/22 weeks if birthweight
unavailable
(WHO National Statistics*)
(80) 4.0 (23) 1.1* (103) 5.1*
3 ?1,000g/28 weeks if birthweight
unavailable
(WHO International/ Standard
Statistics*)
(46) 2.3 (11) 0.5* (57) 2.8*
* Only neonatal deaths within the first 7 days of life are included.
10. Terminations of pregnancy
Total number of induced abortions notified: 4,681
Induced abortion rate per 1,000 women (15-44 years): 14.4
Total induced abortion rate (life-time) per 1,000 women (15-44 years): 430.0
Total first induced abortion rate (life-time) per 1,000 women (15-44 years): 276.1
Induced abortion proportion: 0.19
Pregnancy Outcome in South Australia 2013 page 83
Summary Statistics for 2012
References
1. Scheil W, Scott J, Chan A. South Australian Perinatal Statistics Collection. Guidelines for the Supplementary Birth
Record. Adelaide: Pregnancy Outcome Unit , South Australian Department of Health, 2012.
2. The South Australian Birth Defects Register. 2008/2009 Annual Report. Adelaide: Women s and Children s
Hospital, Children, Youth and Women s Health Service, 2015.
3. Maternal, Perinatal and Infant Mortality Committee. Maternal, Perinatal and Infant Mortality in South Australia
2013. Adelaide: SA Health, Government of South Australia, 2015.
4. Statewide Service Strategy Division. Standards for Maternal and Neonatal Services in SA 2010. Adelaide:
Department of Health, 2010.
5. South Australian Health Commission. Report of the South Australian Birthing Services Working Group. Adelaide:
Social Health and Policy Development Branch, South Australian Health Commission, 1994.
6. South Australian Abortion Reporting Committee. Eleventh Annual Report - For the Year 2013. Adelaide: SA
Health, Government of South Australia, 2015.
7. South Australian Health Commission Epidemiology Branch. Risk factors for adverse perinatal outcome:
determination from a perinatal statistics collection. Adelaide: South Australian Health Commission, December
1986.
8. Mallett R, Knox EG. Standardized perinatal mortality ratios: technique, utility and interpretation. Community
Med 1979; 1: 6-13.
9. AHMC (Australian Health Ministers Conference) 2011. National Maternity Services Plan. Canberra: Australian
Government Department of Health and Ageing.
10. AIHW National Perinatal Epidemiology and Statistics Unit and AIHW 2013. National core maternity indicators.
Cat. no. PER 58. Canberra: AIHW.
Pregnancy Outcome in South Australia 2013page 84
References
Publications
The following is a list of publications from 1985 from the Pregnancy Outcome Unit or which utilised data from the Unit.
Annual Reports
1. Pregnancy Outcome in South Australia (from 1985), website: www.sahealth.sa.gov.au
2. Maternal, Perinatal and Infant Mortality in South Australia. Annual Report of the Maternal, Perinatal & Infant
Mortality Committee (from 1985), website: www.sahealth.sa.gov.au
3. Committee appointed to examine and report on abortions notified in South Australia Annual Report (from 1985
to 2002). South Australian Abortion Reporting Committee Annual Report (from 2003).
4. Pregnancy and Neonatal Care Bulletin (from 1985): for individual hospitals.
The Unit provides birth defects data to the South Australian Birth Defects Register at the Women s and Children s
Hospital and perinatal and birth defects data to the Australian Institute of Health and Welfare National Perinatal
Statistics Unit in Sydney for their reports.
These reports are as follows:
1. The South Australian Birth Defects Register Annual Report (from 1986).
2. Congenital anomalies in Australia (from 1981)
South Australian Birth Defects Register, Public Health Research Unit, Women s and Children s Hospital,
Children, Youth and Women s Health Service, 72 King William Road, North Adelaide, South Australia 5006.
Telephone (08) 8161 6518
Website: www.sahealth.sa.gov.au/pregnancyoutcomes
3. Australia s Mothers and Babies (from 1991)
AIHW National Perinatal Statistics Unit, Sydney Children s Hospital, Level 2, McNevin Dickson Building,
Randwick Hospital Campus, Randwick NSW 2031.
Telephone (02) 9382 1014
Website: www.npsu.unsw.edu.au
Other reports/papers
1. Birth defects
1. Jonas O, Stern LM, Macharper T. A South Australian Study of Pregnancy and Birth Risk Factors associated
with Cerebral Palsy. Int J Rehab Research 1989; 12 (2): 159-166.
2. Chan A, Robertson EF, Haan EA, Keane RJ, Ranieri E, Carney A. Prevalence of neural tube defects in South
Australia, 1966 91: effectiveness and impact of prenatal diagnosis. BMJ 1993; 307: 703-6.
3. Bower C, Norwood F, Knowles S, Chambers H, Haan E, Chan A. Amniotic band syndrome: a population-
based study in two Australian States. Paediatr Perinat Epidemiol 1993; 7: 395-403.
4. Chan A, Robertson E, Haan E, Ranieri E, Keane R. The sensitivity of ultrasound and serum alpha-fetoprotein
in population-based antenatal screening for neural tube defects in South Australia 1986-1991. Br J Obstet
Gynaecol 1995; 102 :370-376.
5. Chan A, Keane RJ, Hanna M, Abbott M. Terminations of pregnancy for exposure to oral retinoids in South
Australia, 1985-1993. Aust NZ J Obstet Gynaecol. 1995; 35 : 422-426.
6. Byron-Scott R, Chan A, Haan EA, Bower C, Scott H, Clark K. A population-based study of abdominal wall
defects in South Australia and Western Australia. Proceedings, 14th Annual Congress Australian Perinatal
Society, Adelaide, March 1996, P82.
7. Chan A, Hanna M, Abbott M, Keane RJ. Oral retinoids and pregnancy. MJA 1996;165: 164-167.
8. Chan A, McCaul KA, Cundy P, Haan EA, Byron-Scott R. Perinatal risk factors for developmental dysplasia of
the hip. Arch Dis Child 1997; 76 : F94 F100.
Pregnancy Outcome in South Australia 2013 page 85
Publications
9. Yiv BC, Saidin R, Cundy PJ, Tgetgel JD, Aguilar J, McCaul KA, Keane RJ, Chan A, Scott H. Developmental
dysplasia of the hip in South Australia in 1991: Prevalence and risk factors. J. Paediatr Child Health 1997;
33: 151-6.
10. Cheffins T, Chan A, Keane RJ. The effects of rubella immunisation in South Australia. Proceedings, Rights to
Health 29th Annual Conference, Public Health Association of Australia Inc., Melbourne, 5-8 October 1997.
11. Byron-Scott R, Haan E, Chan A, Bower C, Scott H, Clark K. A population-based study of abdominal wall
defects in South Australia and Western Australia. Paediatr Perinat Epidemiol. 1998; 12: 136-151.
12. Cheffins T, Chan A, Keane RJ, Hann EA, Hall R. The impact of rubella immunisation on the incidence of
rubella, congenital rubella syndrome and rubella-related terminations of pregnancy in South Australia. Br J
Obstet Gynaecol 1998; 105: 998-1004.
13. Chan A, McCaul K, Keane RJ, Haan EA. Effect of parity, gravidity, previous miscarriage, and age on the risk
of Down s syndrome : population-based study. BMJ 1998; 317: 923-4.
14. Byron-Scott R. et al. A validation study of congenital heart defects in South Australia. Proceedings,
Australian Birth Defects Society. Annual Scientific Meeting. Sydney 1998.
15. Byron-Scott R. et al. A comparison of selected birth defects in Aboriginal and non-Aboriginal babies in
South Australia. Proceedings, Australian Birth Defects Society. Annual Scientific Meeting, Sydney 1998.
16. Byron-Scott R. Richardson M, Hiller J, Chan A, Haan E, Knight B, Adams P. The prevalence and validation
of congenital heart defects in South Australia, 1986-94. Proceedings of the 3rd Annual Congress of the
Perinatal Society of Australia and New Zealand, Melbourne, 1999. P153.
17. Chan A, Cundy PJ, Foster BK, Keane RJ, Byron-Scott R. Late diagnosis of congenital dislocation of the hip and
presence of a screening programme. South Australian population-based study. Lancet 1999;354:1514-17.
18. Chan A, Cundy PJ, Foster BK, Keane RJ, Byron-Scott R. Screening for congenital dislocation of the hip
(letter). Lancet 2000;355:232-33.
19. Chan A, Pickering J, Haan EA, Netting M, Burford A, Johnson A, Keane RJ. Folate before pregnancy : the
impact of a South Australian health promotion campaign on women and health professionals. Western
Australian Birth Defects Registry Twentieth Anniversary Scientific Symposium April 27-28, 2000. Perth,
Western Australia. Teratology 2000;62: 365.
20. Cheffins T, Chan A, Haan EA, Ranieri E, Ryall RG, Keane RJ, Byron-Scott R, Scott H, Gjerde EM, Nguyen
A-M, Ford JH, Sykes S. The impact of maternal serum screening on the birth revalence of Down s syndrome
and the use of amniocentesis and chorionic villus sampling in South Australia. Br J Obstet Gynaecol
2000;107:1453-9.
21. Chan A, Pickering J, Haan EA, Netting M, Burford A, Johnson A, Keane RJ. Folate before pregnancy :the
impact on women and health professionals of a population-based health promotion campaign in South
Australia. MJA 2001; 174:631-636.
22. Chan A, Foster BK, Cundy PJ. Invited commentary. Problems in the diagnosis of neonatal hip instablity. Acta
Paediatr 2001;90:836-9.
23. Metz MP, Ranieri E, Gerace RL, Priest KR, Luke CG, Chan A. Newborn screening in South Australia: is it
universal? MJA 2003;179:412-415.
24. Chan A. Invited commentary: Parity and the risk of Down syndrome caution in interpretation. Am J
Epidemiol 2003;158:509-511.
25. Gibson CS, MacLennan AH, Hague WM, Rudzki Z, Sharpe P, Chan A, Dekker GA. Fetal thrombophilic
polymorphisms are not a risk factor for cerebral palsy. Perinatal Society of Australia and New Zealand 8th
Annual Congress, Convention Centre, Darling Harbour, Sydney, Australia, 15th-18th March 2004, A41.
26. Gibson CS, MacLennan AH, Rudzki Z, Hague WM, Haan EA, Sharpe P, Priest K, Chan A, Dekker GA for the
South Australian Cerebral Palsy Research Group. The prevalence of inherited thrombophilias in a Caucasian
Australian population. Pathology 2005;37:160-163.
Pregnancy Outcome in South Australia 2013page 86
Publications
27. Byron-Scott R, Sharpe P, Hasler C, Cundy P, Hirte C, Chan A, Scott H, Baghurst PB, Haan E. A South Australian
population-based study of congenital talipes equivarus. Paediatr Perinat Epidemiol 2005;19:227-237.
28. Gibson CS, MacLennan AH, Hague WM, Haan E, Priest K, Chan A, Dekker GA for the South Australian
Cerebral Palsy Research Group. Associations between inherited thrombophilias, gestational age and
cerebral palsy. Am J Obstet Gynecol 2005;193:1437.e1-1437.e12.
29. Sharpe PB, Chan A, Haan EA, Hiller JE. Maternal diabetes and congenital anomalies in South Australia 1986-
2000: a population-based cohort study. Birth Defects Research Part A Clin Mol Teratol 2005:73;605-611.
30. Gibson CS, MacLennan AH, Goldwater PN, Haan EA, Priest K, Dekker GA for the South Australian Cerebral
Palsy Research Group. Neurotropic viruses and cerebral palsy: a population bases case-control study. BMJ
,doi:10.1136/bmj.38668.616806.3A (published 6 January 2006).
31. Sharpe PB, Mulpuri K, Chan A, Cundy P. Differences in risk factors between early and late diagnosed DDH.
Arch Dis Child 2006;91:F158-162.
32. Gibson CS, MacLennan AH, Goldwater PN, Haan EA, Priest K, Dekker GA for the South Australian Cerebral
Palsy Research Group. The association between inherited cytokine polymorphisms and cerebral palsy. Am J
Obstet Gynecol 2006;194: 674.e1-674.e11.
33. Gibson CS, MacLennan AH, Janssen NG, Kist WJ, Hague WM, Haan EA, Goldwater PN, Priest K, Dekker GA
for the South Australian Cerebral Palsy Research Group. Associations between fetal inherited thrombophilia
and adverse pregnancy outcomes. Am J Obstet Gynecol 2006; 194: 947.e1-947.e10.
34. Gibson CS, MacLennan AH, Dekker GA, Goldwater PN, Dambrosia JM, Munroe DJ, Tsang S, Stewart C,
Nelson KB. Genetic polymorphisms and spontaneous preterm birth. Obstet Gynecol 2007;109:384-391.
35. Muller PR, Cocciolone R, Haan EA, Wilkinson C, Scott H, Sage L, Bird R, Hutchinson R, Chan A. Trends in
state/population-based Down syndrome screening and invasive prenatal testing with the introduction of
first-trimester combined Down syndrome screening, South Australia, 1995-2005. Am J Obstet Gynecol
2007;196:315.e1-315.e7.
36. Gibson CS, MacLennan AH, Goldwater PN, Haan EA, Priest K, Dekker GA for the South Australian Cerebral
Palsy Research Group. Mannose-binding lectin haplotypes may be associated with cerebral palsy only after
perinatal viral exposure. Am J Obstet Gynecol 2008;198:509.e1-509.e8.
37. Khoo NS, van Essen P, Richardson M, Robertson T. Effectiveness of prenatal diagnosis of congenital heart
defects in South Australia: a population analysis 1999-2003. Aust NZ J Obstet Gynaecol 2008;48:559-563.
38. Chan AC, van Essen P, Scott H, Haan EA, Sage L, Scott J, Gill TK, Nguyen A-M T. Folate awareness and the
prevalence of neural tube defects in South Australia, 1966-2007. MJA 2008;189: 566-569.
39. Djukic M, Gibson CS, MacLennan AH, Goldwater PN, Haan EA, McMichael G et al. Genetic susceptibility to
viral exposure may increase the risk of cerebral palsy. Aust NZ J Obstet Gynaecol 2009: 49:247-253.
40. De Souza, Halliday J, Chan A, Bower C, Morris JK. Recurrence risks for trisomies 13,18, and 21. Am J Med
Genet Part A 149A:2716 2722.
41. Davies MJ, Moore VM, Willson KJ, Van Essen P, Priest K, Scott H, et al. Reproductive technologies and the
risk of birth defects. N Engl J Med. 2012 May 10;366(19):1803-13. PubMed PMID: 22559061.
42. Flood L, Scheil W, Nguyen A, Sage L, Scott J. An increase in neural tube defect notifications, South
Australia, 2009 2010. Western Pacific Surveillance and Response Journal, 2013, 4 (2). doi:10.5365/
wpsar.2012.3.3.006
Pregnancy Outcome in South Australia 2013 page 87
Publications
2. Termination of pregnancy
1. Hart G, Macharper T. Medical termination of pregnancy in South Australia 1970-1984. Adelaide: South
Australian Health Commission, 1986.
2. Chan A, Taylor A. Medical Termination of Pregnancy in South Australia - The First 20 Years 1970-1989.
Adelaide: Pregnancy Outcome Unit, South Australian Health Commission, December 1991.
3. Chan A, McColl M, Versteeg J, Gameau B, Scanlan C, Pridmore B. A South Australian Study on
Contraception and Abortion. Public and Environmental Health Service, South Australian Health Commission
and Department of Obstetrics and Gynaecology, The Queen Elizabeth Hospital, Adelaide, March 1994.
4. Hart G, Macharper T. Clinical aspects of induced abortion in South Australia from 1970-1984. Aust. NZ J
Obstet Gynaecol 1986; 26: 219-224.
5. Hart G, Macharper T. Induced abortion trends in South Australia. Am J Public Health 1987; 77: 200-202.
6. Chan A, Keane RJ. Prevalence of induced abortion in a reproductive lifetime. Am J Epidemiol
2004;159:475-480.
7. Chan A, Sage LC. Estimating Australia s abortion rates 1985-2003. MJA 2005;182:447-452.
3. Perinatal epidemiology
1. Connon AF, Macharper T. Teenage pregnancies in South Australia. Adelaide: South Australian Health
Commission, September 1986.
2. South Australian Health Commission, Epidemiology Branch: Characteristics of pregnancies and births
among migrant women in South Australia. Adelaide : South Australian Health Commission, October 1986.
3. South Australian Health Commission, Epidemiology Branch. Risk factors for adverse perinatal outcome:
determination from a perinatal statistics collection. Adelaide: South Australian Health Commission,
December 1986.
4. South Australian Health Commission, Epidemiology Branch. Variation in perinatal risk by place of residence
of mother in South Australia. Adelaide: South Australian Health Commission, December 1986.
5. South Australian Health Commission, Epidemiology Branch. Variations in Perinatal Risk by Hospital of Birth
in South Australia. Adelaide: South Australian Health Commission, January 1987.
6. South Australian Health Commission, Epidemiology Branch. Aboriginal Births in South Australia, 1981-
1986: An Analysis of Perinatal Outcomes, Adelaide: South Australian Health Commission, May 1988.
7. South Australian Health Commission, Epidemiology Branch: Pregnancy Outcome Attributes by Postcode:
South Australia 1981-1986. South Australian Health Commission, Adelaide: August 1988.
8. Jonas O, Scott J, Chan A, Macharper T, Lister J. A validation study of the 1986 perinatal data collection
form. Adelaide: Pregnancy Outcome Unit, South Australian Health Commission, 1991.
9. South Australian Cancer Registry. Associations between perinatal characteristics and risk of childhood
cancer: South Australian cancer cases born in 1981-1993. In: Epidemiology of Cancer in South Australia.
Incidence, Mortality and Survival 1977 to 1994. Adelaide South Australian Health Commission, 1995.
10. Taylor A, Twisk A-M, Chan A. Perinatal risk factors by postcode in South Australia 1989-1992. Epidemiology
Branch, South Australian Health Commission, Adelaide: June 1995.
11. Pregnancy Outcome Unit. Perinatal Statistics Collection. Guidelines for the Supplementary Birth Record.
Adelaide: South Australian Health Commission, December 1997.
12. McLean A, Scott J, Keane RJ, Sage L, Chan A. Validation of the 1994 South Australian perinatal data
collection form. Adelaide: Pregnancy Outcome Unit, Department of Human Services, 2001.
13. Hart G, MacHarper T, Moore D, Roder D. Aboriginal pregnancies and births in South Australia. MJA 1985;
143: S54-56.
14. Chan A, Roder D, Macharper, T. Obstetric Profiles of Immigrant Women from Non-English Speaking
Countries in South Australia, 1981-83. Aust NZ J Obstet Gynaecol 1988; 28: 90-95.
Pregnancy Outcome in South Australia 2013page 88
Publications
15. Jonas O, Roder D, Esterman A, Macharper T, Chan A. Pregnancy and Birth Risk Factors for Intellectual
Disability in South Australia. Eur J Epidemiol 1989; 5: 322-327.
16. Jonas O, Chan A, Macharper T, Roder D. Pregnancy and Perinatal Factors associated with persistently low
Apgar scores: an analysis of the birth records of infants born in South Australia. Eur J Epidemiol 1990; 6:
136-141.
17. Crotty M, Ramsay AT, Smart R, Chan A. Planned Homebirths in South Australia 1976-1987 MJA 1990; 153:
664-671.
18. Jonas O, Chan A, Roder D, Macharper T. Pregnancy Outcomes in primigravid women aged 35 years and
over in South Australia, 1986-1988. MJA 1991; 154: 246-249.
19. Zhang B, Chan A. Teenage Pregnancy in South Australia, 1986-1988. Aust. NZ J Obstet Gynaecol 1991; 31:
291-298.
20. Jonas O, Roder D, Chan A. The Association of Maternal and Socioeconomic Characteristics in Metropolitan
Adelaide with Medical, Obstetric and Labour Complications and Pregnancy Outcomes. Aust NZ J Obstet
Gynaecol 1992; 32: 1-5.
21. Chan A, Roder D, Priest K, Esterman A. A perinatal perspective on South Australia in the 1980s. MJA 1992;
157: 515-518.
22. Jonas O, Roder D, Chan A. The association of low socio-economic status in Metropolitan Adelaide with
maternal demographic and obstetric characteristics and pregnancy outcome. Eur J Epidemiol 1992; 8:708.
23. Jonas O, Roder D. Breech Presentation in South Australia, 1987-1989. Aust NZ J Obstet Gynaecol 1993; 33:
17-21.
24. Scott J, Chan A. Planned birthing unit deliveries in South Australia. Proceedings, 14th Annual Congress
Australian Perinatal Society, Adelaide, March 1996, P21.
25. Dal Grande E, Chan A, Keane R. Asian, but different: Obstetric characteristics of women born in Vietnam
and Philippines who delivered in South Australia in 1991-1994. Proceedings, 14th Annual Congress
Australian Perinatal Society, Adelaide, March 1996, P22.
26. Keane R, Dal Grande E, Chan A, McCaul K. Episiotomy a decline in the cutting edge. Proceedings, 14th
Annual Congress Australian Perinatal Society, Adelaide, March 1996, P75.
27. Chan A, McPhee AJ. A safer leap into this dangerous world. Lancet 1996; 348 (suppl II) :12.
28. Carter JR, Hiller JE, Ryan P, Chan A. The Association between maternal age and preterm births to
primiparous women in South Australia, 1991-1993, Proceedings, First Annual Congress, Perinatal Society of
Australia and New Zealand, Fremantle, Western Australia, 16-24 March 1997.
29. Zhang B, Hiller JE, Chan A. Asthma in pregnancy in South Australia. Proceedings, First Annual Congress,
Perinatal Society of Australia and New Zealand, Fremantle, Western Australia, 16-24 March 1997.
30. Roder D, Nguyen A-M, Chan A. Trends in perinatal characteristics in South Australia, 1981 to 1994, by
place of residence of mother. Aust NZ J Public Health 1997; 21: 483-8.
31. Zhang B, Hiller JE, Chan A. Asthma in pregnancy: Association with Spontaneous Preterm Birth. Proceedings
of the 3rd Annual Congress of the Perinatal Society of Australia and New Zealand, Melbourne, 1999, A113.
32. McLean AP, Hiller JE, Chan A. Maternal epilepsy and fetal outcomes in South Australia. Perinatal Society
of Australia and New Zealand 4th Annual Congress. Brisbane Convention and Exhibition Centre, Brisbane,
Australia, 12-15 March 2000, P192.
33. Chan A, Keane RJ, Robinson JS. The contribution of maternal smoking to preterm birth, small for
gestational age and low birthweight among Aboriginal and non-Aboriginal births in South Australia. MJA
2001;174: 389-93.
34. van der Klis KAM, Westenberg L, Chan A, Dekker G, Keane RJ. Teenage pregnancy: trends,characteristics
and outcomes in South Australia and Australia. Aust N Z J Public Health 2002; 26: 125-31.
35. Westenberg L, van der Klis KAM, Chan A, Dekker G, Keane RJ. Aboriginal teenage pregnancies compared
with non-Aboriginal in South Australia 1995-1999. Aust N Z J Obstet Gynaecol 2002;42: 187-191.
36. Wang JX, Knottnerus A-M, Schuit G, Norman RJ, Chan A, Dekker GA. Surgically obtained sperm and risk of
gestational hypertension and pre-eclampsia. Lancet 2002;359: 673-4.
Pregnancy Outcome in South Australia 2013 page 89
Publications
37. Jacobs DJ, Vreeburg SA, Dekker GA, Heard AR, Priest KR, Chan A. Risk factors for hypertension during
pregnancy in South Australia. Aust NZ J Obstet Gynaecol 2003; 3: 421-428.
38. Heard AR, Dekker GA, Chan A, Jacobs DJ, Vreeburg SA, Priest KR. Hypertension during pregnancy in South
Australia, Part 1: Pregnancy outcomes. Aust NZ J Obstet Gynaecol 2004; 44: 404-409.
39. Vreeburg SA, Jacobs DJ, Dekker GA, Heard AR, Priest KR, Chan A. Hypertension during pregnancy in South
Australia, Part 2: Risk factors for adverse maternal and/or perinatal outcome results of multivariable
analysis. Aust NZ J Obstet Gynaecol 2004;44: 410-418.
40. Leahy K, Elliot E, Kennare R, Chan A. Characteristics and pregnancy outcomes of first time mothers aged
35 years and over compared to younger first time mothers in South Australia 1991-2002. Before and
Beyond Birth. Abstract Book. Perinatal Society of Australia and New Zealand 9th Annual Congress. Adelaide
Convention Centre, Adelaide, South Australia, 13-16 March 2005, A144.
41. Kennare R, Heard A, Chan A. Substance use during pregnancy: risk factors and obstetric and perinatal
outcomes in South Australia. Aust NZ J Obstet Gynaecol 2005;45:220-225.
42. Freak-Poli R, Chan A, Tucker G, Street J. Previous abortion and risk of spontaneous preterm birth. Perinatal
Society of Australia and New Zealand 10th Annual Congress. Perth Convention Exhibition Centre, Perth,
Western Australia, 3-6 April 2006, FC17.1, p 165.
43. Scott J, Chan A. South Australian Perinatal Statistics Collection. Guidelines for the Supplementary Birth
Record. Adelaide: Pregnancy Outcome Statistics Unit, South Australian Department of Health, 2006.
44. Budde MP, De Lange TE, Dekker GA, Chan A, Nguyen AM. Risk factors for placental abruption in a socio-
economically disadvantaged region. J Matern Fetal Neonat Med 2007 Sep; 20(9):687-93.
45. Freak-Poli R, Chan A, Tucker G, Street J. Previous abortion and risk of pre-term birth: a population study. J
Matern-Fetal Neonat Med 2009;22(1):1-7.
46. Kennare R, Keirse M, Tucker G, Chan A. Planned home and hospital births in South Australia, 1991 2006:
differences in outcomes. MJA 2010; 192: 76 80.
47. Dodd J, Grivell R, Nguyen AM, Chan A, Robinson J. Maternal and perinatal health outcomes by body mass
index category. ANZJOG 2011: 51,2: 136 140.
48. Grivell RM, Reilly AJ, Oakey H, Chan AC, Dodd JM. Maternal and neonatal outcomes following induction of
labor: a cohort study. Acta Obstet Gynecol Scand 2012; 91:198 203.
49. Ludford I, Scheil W, Tucker G, Grivell R. Pregnancy outcomes for nulliparous women of advanced maternal
age in South Australia, 1998-2008. The Australian & New Zealand Journal of Obstetrics & Gynaecology.
2012 Jun;52(3):235-41. PubMed PMID: 22553967.
50. Dodd JM, Catcheside B, Scheil W. Can shoulder dystocia be reliably predicted? The Australian & New
Zealand Journal of Obstetrics & Gynaecology. 2012 Jun;52(3):248-52. PubMed PMID: 22428758.
51. Hodyl NA, Stark MJ, Scheil W, Clifton VL. Maternal asthma is a significant contributor to neonatal morbidity.
Journal of Developmental Origins of Health and Disease 01/2011; 2:S120-S121.
52. Hodyl NA, Stark MJ, Scheil W, Grzeskowiak LE, Clifton VL. Perinatal outcomes following maternal asthma
and cigarette smoking during pregnancy. European Respiratory Journal: 2013 erj00549-02013.
53. Baghurst, P, Robson, S, Antoniou, G, Scheil, W and Bryce, R. The association between increasing maternal
age at first birth and decreased rates of spontaneous vaginal birth in South Australia from 1991 to 2009.
Australian and New Zealand Journal of Obstetrics and Gynaecology, 2014; 54:237 243. doi:10.1111/
ajo.12182.
54. Baghurst P. The case for retaining severe perineal tears as an indicator of the quality for obstetric care.
ANZJOG 2013; 53(1): 3-8.
55. Hodyl NA, Grzeskowiak LE,Stark MJ, Scheil W, Clifton VL. The impact of Aboriginal status, cigarette
smoking and smoking cessation on perinatal outcomes in South Australia. MJA 2015; 201(5): 274-278.
56. Smithers LG, Searle AK, Chittleborough CR, Scheil W, Brinkman SA, Lynch JW. A whole-of-population
study of term and post-term gestational age at birth and children s development. BJOG 2015; DOI:
10.1111/1471-0528.13324.
Pregnancy Outcome in South Australia 2013page 90
Publications
4. Perinatal mortality
1. Roder D, Chan A, Esterman A. Birthweight specific trends in perinatal mortality by hospital category in
South Australia, 1985 1990. MJA 1993; 158: 664-667.
2. Connon AF, Chan A on behalf of the Postneonatal Subcommittee, maternal, perinatal and Inmfant
Mortality Committee. Accidental deaths of babies in the postneonatal period in South Australia (letter).
MJA 1994;161:397.
3. Roder D, Chan A, Priest K. Perinatal mortality trends among South Australian Aboriginal births 1981-92. J
Paediatr Child Health 1995; 31: 446-450.
4. Haslam R, McPhee A, Chan A, Keane R. Neonatal mortality a system of classification and trends in South
Australia. Proceedings of the 3rd Annual Congress of the Perinatal Society of Australia and New Zealand,
Melbourne, 1999. P86.
5. Robson S, Chan A, Keane RJ, Luke CG. Subsequent birth outcomes after an unexplained stillbirth:
preliminary population-based retrospective cohort study. Aust NZ J Obstet Gynaecol 2001;41: 29-35.
6. Flenady V, Chan A, Haslam R, King J, Tudehope D, McCowan L. Cause specific perinatal mortality in
Australia and New Zealand using a new clinical classification system (ANZACPM and ANZNDC). Perinatal
Society of Australia and New Zealand 7th Annual Congress, Hotel Grand Chancellor, Hobart, Tasmania,
March 9th-12th 2003, A87.
7. Dodd JM, Robinson JS, Crowther CA, Chan A. Stillbirth and neonatal outcomes in South Australia, 1991-
2000. Am J Obstet Gynecol 2003;189: 1731-1736.
8. Chan A, King JF, Flenady V, Haslam RH, Tudehope DI. Classification of perinatal deaths: Development of the
Australian and New Zealand classifications. J Paediatr Child Health 2004;40: 340-347.
9. Flenady V, King J, Chan A, McCowan L, Tudehope D, Haslam R, Charles A, Roberts C for the Perinatal
Mortality Audit Guidelines Working Party of the PSANZ Perinatal Mortality Special Interest Group.
Development of Clinical Practice Guideline for Perinatal Mortality Audit incorporating psychological and
social aspects of perinatal bereavement. Before and Beyond Birth. Abstract Book. Perinatal Society of
Australia and New Zealand 9th Annual Congress, Adelaide Convention Centre, Adelaide, South Australia,
13-16 March 2005, P58.
10. De Lange TE, Budde MP, Heard AR, Tucker G, Kennare R, Dekker GA. Avoidable risk factors in perinatal
deaths: a perinatal audit in South Australia. Aust NZ J Obs Gynaecol 2008;48:50-57.
11. Kennare R, Scheil W, Tucker G. A public health approach to review of sudden unexpected infant deaths
challenges and interventions. Australian Journal of Child and Family Health Nursing 2015; 12: 1.
5. Caesarean section
1. Jonas O, Chan A, Macharper T. Caesarean Section in South Australia, 1986. Aust NZ J Obstet Gynaecol
1989; 29: 99-106.
2. Chan A. Epidemiology of the rising Caesarean section rate. Proceedings, 14th Annual Congress Australian
Perinatal Society, Adelaide, March 1996, A70.
3. Chan A, Keane RJ, Scott J. Elective Caesarean section and child deprivation (letter). Lancet 1996; 347:
1196.
4. Kennare, R. Why is the caesarean section rate rising? MIDIRS Midwifery Digest 2003; 13 (4): 503-508.
5. Kennare R, Heard A, Chan A. Is caesarean section in the first birth a problem for women in the next
birth? Before and Beyond Birth. Abstract Book. Perinatal Society of Australia and New Zealand 9th Annual
Congress. Ade;laide Convention Centre, Adelaide, South Australia, March 13-16 2005, A 127.
6. Kennare R, Tucker G, Heard A, Chan A. Risks of adverse outcomes in the next birth after caesarean delivery.
Obstet Gynecol 2007;109:270-276.
7. Dekker G, Chan A, Luke C, Priest K, Riley M, Halliday J, King J, Gee V, O Neill M, Snell M, Cull V, Cornes S.
Risk of uterine rupture in Australian women attempting vaginal birth after one prior caesarean section: a
retrospective population-based cohort study. BJOG 2010;117:1358 1365.
Pregnancy Outcome in South Australia 2013 page 91
Publications
Appendix 1: Definitions
Abortion rate:
= x 1,000
Estimated resident population of same group in the same year
Number of induced abortions in a group of women in a year
The abortion rate per 1,000 women in the reproductive age group 15-44 years has been calculated in this report
using as the numerator all abortions; the denominator used has been the estimated resident population for women
aged 15-44 years in that year.
Abortion proportion:
Abortions + live births
Abortions
=
This is often called the abortion ratio, which is strictly:
Live births
Abortion
Apgar score: A numerical scoring system applied after birth (usually at 1 minute and again at 5 minutes) to evaluate
the condition of the baby, as specified below:
Sign
Score
0 1 2
Heart rate Absent Slow (below 100) Over 100
Respiratory effort Absent Slow, irregular Good, crying
Muscle tone Flaccid Some flexion of extremities Active motion
Reflex irritability No response Grimace Vigorous cry
Colour Blue, pale Body pink, extremities blue Completely pink
Birthweight: The first weight of a fetus or newborn obtained after birth. This is preferably measured within the first
hour of life before significant post-natal weight loss has occurred.
Low birthweight: Birthweight of less than 2,500g.
Very low birthweight: Birthweight of less than 1,500g.
Body Mass Index (BMI): weight (in kg) height2 (in metres).
This is used as a standard for recording obesity statistics and also as a measure of underweight. However the
categories do not take into account factors such as frame size, muscularity, varying proportions of components such
as fat, bone, cartilage and water, and may be misleading in athletes, children and some ethnic groups. The categories
for describing weight using BMI are:
BMI category Name
<18.5 Underweight
18.5 to < 25 Normal
25 to < 30 Overweight
30 to < 35 Obese
35 to < 40 Severely obese
40 or greater Morbidly obese
Pregnancy Outcome in South Australia 2013page 92
Appendix
Caesarean section: Birth of a child by an abdominal operation.
Elective caesarean section: One which takes place as a planned procedure before the spontaneous onset
of labour.
Emergency caesarean section: One which is undertaken for a complication:
(a) before the onset of labour or
(b) during labour, whether that labour is of spontaneous onset or following induction of labour.
Fertility rates:
Age-specific fertility rate:
Estimated resident population of women of that age group in the same year
Number of live births to women in an age group in a year
x 1,000
General fertility rate:
Estimated resident population of womens aged 15 - 44 years in the same year
Total number of live births in a year
x 1,000
Total fertility rate (TFR): The sum of age-specific fertility rates (live births at each age of women per female
population of that age). It represents the number of children a woman would bear during her lifetime if she
experienced current age-specific fertility rates at each age of her reproductive life.
Gestational age: The duration of pregnancy in completed weeks determined by the best obstetric estimate, using
ultrasonography and the first day of the last normal menstrual period.
Induction of labour: An intervention undertaken to stimulate the onset of labour by pharmacological or other
means.
Live birth: The complete expulsion or extraction from its mother of a product of conception, irrespective of the
duration of pregnancy, which after such separation breathes or shows any other evidence of life, such as beating of
the heart, pulsation of the umbilical cord or definite movement of voluntary muscles, whether or not the umbilical
cord has been cut or the placenta is attached.
Maternal death is defined as the death of a woman while pregnant or within 42 days of termination of pregnancy,
irrespective of the duration and the site of the pregnancy, from any cause related to or aggravated by the pregnancy
or its management but not from accidental or incidental causes.1
Maternal deaths are divided into two groups:
1. Direct obstetric deaths: those resulting from obstetric complications of the pregnant state (pregnancy, labour and
puerperium) from interventions, omissions, incorrect treatment, or from a chain of events resulting from any of the above.
2. Indirect obstetric deaths: those resulting from previous existing disease or disease that developed during pregnancy
and which was not due to direct obstetric causes, but which was aggravated by physiologic effects of pregnancy.
As an extension of the WHO definition, accidental and incidental deaths occurring in pregnant women are also
reviewed by the Maternal, Perinatal and Infant Mortality Committee so as to avoid missing indirect deaths which may
be difficult to distinguish from incidental deaths. Examples of incidental deaths are deaths from drowning and road
accidents, where the pregnancy is unlikely to have contributed significantly to the death, although it may be possible
to postulate a remote association.
Multigravida: A woman who has been pregnant more than once.
Parity: The total number of previous pregnancies resulting in live births or stillbirths.
1 World Health Organisation. International Statistical Classification of Diseases and Related Health Problems. Tenth Revision. Volume 2. Geneva: WHO,
1993, p 134.
Pregnancy Outcome in South Australia 2013 page 93
Appendix
Perinatal deaths:
Early fetal death: Death in a fetus of less than 400g birthweight, and of less than 20 weeks gestation. A
miscarriage is a spontaneous early fetal death.
Fetal death: Death prior to the complete expulsion or extraction from a woman of a product of conception,
irrespective of the duration of pregnancy; the death is indicated by the fact that after such separation the
fetus does not breathe or show any other evidence of life, such as beating of the heart, pulsation of the
umbilical cord, or definite movement of voluntary muscles.
Late fetal death or stillbirth: Death in a fetus of at least 400g birthweight, or of at least 20 weeks gestation.
Late fetal death rate or stillbirth rate:
= x 1,000
Number of live births and still births in that year
Number of late fetal deaths or stillbirths in any year
Neonatal death: Death of a liveborn infant within 28 days of birth.
Neonatal death rate:
= x 1,000
Number of live births in that year
Number of neonatal deaths in any year
Perinatal death: Includes late fetal death (stillbirth) and neonatal death.
Perinatal mortality rate (PMR):
= x 1,000
Number of stillbirths and live births
Number of stillbirths and neonatal deaths
For South Australian statistics, the rate refers to live births and stillbirths of at least 400g birthweight or 20
weeks gestation.
For national statistics, the rate refers to all births of at least 20 weeks gestation or 400g birthweight, and
neonatal deaths occurring within 28 days of birth.
For international comparison, the rate refers to all births of at least 1,000g birthweight or, when birthweight
is unavailable, of at least 28 weeks gestation and neonatal deaths occurring within seven days of birth (as
recommended by WHO).
Preterm: less than 37+0 completed weeks gestation.
Primigravida: A woman pregnant for the first time.
Primipara: A pregnant woman who has had no previous pregnancy resulting in a live birth or stillbirth.
Race
1. Caucasian: individuals of European descent.
2. Aboriginal: this includes part-Aboriginals as well as full blood Aboriginals. An Aboriginal is a person of
Aboriginal descent who identifies as an Aboriginal and is accepted as such by the community in which he
or she lives.
3. Asian: (exclude Asia Minor) - In this category, include women originating from all Asian countries,
including the Indian subcontinent (India, Bangladesh, Pakistan, Nepal, Sri Lanka), who were formerly
listed as Other race.
4. Torres Strait Islander (TSI): A Torres Strait Islander is a person of Torres Strait Islander descent who
identifies as a Torres Strait Islander and is accepted as such by the community in which he or she lives.
5. Aboriginal & TSI: persons of both Aboriginal and Torres Strait Islander descent.
6. Other: Races other than (1) - (5). Include women from the Middle East and Africa.
Pregnancy Outcome in South Australia 2013page 94
Appendix
Guidelines for use regarding Indigenous Status - categories (2), (4) and (5).
There are three components to the definition:
> descent
> self identification
> community acceptance
It is not possible to collect the three components of the definition in a single question. The Australian Bureau
of Statistics (ABS) proposes that the focus of a single question should be the descent, the first component
of the definition. The ABS therefore proposes the use of the following alternative questions, depending on
whether the person is present or not.
Where the person is present : Are you of Aboriginal or Torres Strait Islander origin? ;
OR
where the person is not present and someone who knows the person well responds for him/her: Is the
person of Aboriginal or Torres Strait Islander origin?
If the response is Yes , then clarify whether the person is of Aboriginal origin (2), Torres Strait Islander
origin (4) or both Aboriginal and Torres Strait Islander origin (5).
Self reporting of descent is not equivalent to self reporting of identity but because of the absence of a
second identity question some respondents will interpret the origin question to mean both descent and
identification. What identification in the context of the variable Indigenous Status should measure is an
individual s self assessed historical and cultural affiliation.
Termination of pregnancy: (synonym induced abortion) The removal or expulsion of a pregnancy from the uterus
via surgical or medical intervention, performed by a medical practitioner in a prescribed hospital in South Australia,
on specified grounds under the Criminal Law Consolidation Act and notified under the Criminal Law Consolidation
(Medical Termination of Pregnancy) Regulations 1996. Terminations of pregnancy at gestations of 20 weeks or later or
where the fetus weighs at least 400g, performed by induction of labour resulting in a birth are included in the South
Australian perinatal data collection. These are usually for congenital abnormalities or medical reasons.
Total abortion rate = the sum of the five-year age-specific induced abortion rates multiplied by 5.
This represents the number of induced abortions 1,000 women would have during their lifetime if they experienced
the rates of the year shown.
Pregnancy Outcome in South Australia 2013 page 95
Appendix
Appendix 2: 2013 Supplementary Birth Record Form
Appendix
Pregnancy Outcome in South Australia 2013page 96
Appendix 3: Congenital Abnormality Form
Appendix
Pregnancy Outcome in South Australia 2013 page 97
For more information
Pregnancy Outcome (Statistics) Unit
Epidemiology Branch
SA Health, Government of South Australia
Citi Centre Building
11 Hindmarsh Square
Adelaide 5000 South Australia
Postal Address
Pregnancy Outcome (Statistics) Unit
SA Health, Government of South Australia
PO Box 6 Rundle Mall
Adelaide 5000 South Australia
Telephone: (08) 8226 6382
Fax: (08) 8226 6291
Web: www.sahealth.sa.gov.au/pregnancyoutcomes
E-mail: Pregnancy.Stats@health.sa.gov.au
Public-I2-A1
Department for Health and Ageing, Government of South Australia.
All rights reserved. FIS: 15116.1 ISSN: 0819-3835 ISBN: 978-1-74243-807-8 Printed November 2015.
www.ausgoal.gov.au/creative-commons
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